HTA adoption in Asian emerging pharma markets
Asia's emerging markets - such as Indonesia, Vietnam, and the Philippines - may provide a significant growth opportunity of pharmaceutical multinationals. Compared to the more mature pharma markets in Japan, South Korea and Thailand, for example, Asia's emerging pharma markets typically boast a younger, growing population, less domestic competition and a hunger for innovative treatments. However, those days may be numbered. Populations in Vietnam and Indonesia, in particular, are ageing fast, and with that trend comes the governments' increasing concern over how to afford healthcare and medicines in the future. These factors are driving increasing interest in health technology assessment (HTA) in Asian emerging markets.
"Lots of emerging markets are looking to establish formal HTAs," Jie Shen, Global Head of Pricing & Value Policy at Novartis said at The Pharma Market Access and Pricing Summit Asia conference last week. However, it would be "very dangerous for any country to just take on an HTA system from somewhere else," she added. It is key for each market to adopt a localized approach that suits the local pharma landscape, rather than simply adopt a purely cost / QALY (quality-adjusted life-year) approach.
Unlike Europe, which has invested heavily in cross-border cooperation between HTA agencies such as eunethta, Asia remains split in terms of HTA adoption. In Asia's more mature markets, HTA has long been present: Thailand first implemented HTA in 2010, under its Health Intervention and Technology Assessment Program (HITAP); South Korea has required HTA since 2006 to include medicines and medical devices in its reimbursement list; and Taiwan's Center for Drug Evaluation (CDE) established the Health Technology Assessment division in 2008. Meanwhile, Japan and China are increasingly integrating HTA into their healthcare and drug pricing systems.
However, emerging Asian markets present a different picture. The Philippines, Indonesia and Vietnam have elements of an informal HTA program and are largely still in the discussion stages, and while Malaysia does have a formal HTA program (MaHTAS), its scope is limited due to lack of comprehensive databases and skilled personnel. However, as healthcare spending soars in these markets, that picture is expected to change soon.
What will HTA adoption look like in Asia's emerging pharma markets? Given current trends and the lack of regional coordination, it seems likely that each market will consider a highly-localized model with limited scope for cross-border initiatives. Jie of Novartis said that the multiple criteria decision analysis (MCDA) methodology may be more suited to emerging markets, as it allows for each government to adjust value criteria more flexibly according to public health priorities, rather than adopt a strict QALY-based approach. Whatever happens, pharma companies should expect an increasingly stringent application of value assessment
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