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HTA makes headway in the Kingdom: The restructuring of Saudi's Ministry of Health in context
The Saudi Ministry of Health is no stranger to change - in the last six years, it has seen as many ministers step in to assume its leadership. This churn at the top has also fed through into the membership of the organisation's pharmacy & therapeutics committee, leading to a certain degree of unpredictability. Thus the recent announcement of more change, including the intent to devolve greater responsibilities to the deputy minister as part of a restructuring drive, might be brushed aside as more of the same.
Yet part of that restructure, according to news sources, will also focus on the establishment of a new department of health economics within the Ministry. We here in the IHS Life Sciences team view this development with particular interest, following on from conversations we had with various Saudi stakeholders as part of our recent study on the evolving MENA landscape. Indeed, a number of policymakers drew attention to behind-the-scenes efforts and longer-term ambitions to bolster HTA capabilities in Saudi. As such, we thought this announcement might be worthy of placing in context.
The MOH in context
The MOH in Saudi, designed to provide healthcare services broadly accessible to citizens, is one of a number of players in the country's multi-payer system. It is joined by a variety of other ministries and agencies which provide health services for their own subsets of the population. The MOH, thought to account for just under 60% of all healthcare services, constitutes the single largest buyer of medicines in the country.
The MOH manages a national formulary through a central P&T committee. At present, the Ministry itself does not tend to request dossier submissions from manufacturers, but undertakes its own research into supporting evidence. Clinical trial data and inclusion of the medicine in international guidelines tend to weigh heavily in formulary deliberations. Decision-making timelines reportedly vary, with some industry stakeholders quoting us timeframes of well over a year.
In terms of procurement, the MOH is obliged to purchase at least half of its pharmaceutical products via the National Unified Procurement Company for Medical Supplies (NUPCO). This government-owned entity, in addition to centralised tendering, is also responsible for the warehousing and distribution of pharmaceuticals on behalf of public hospitals and healthcare facilities. The MOH may also procure medicines through a Gulf Cooperation Council-wide group purchasing programme organised by the Executive Body of the Health Ministers' Council. Open to all seven GCC member states, Saudi is recognized as being one of the more extensive users of this system. A third option, often used for expensive biologics and oncology medicines, is direct purchase at hospital level from the manufacturer.
Interestingly, in our research on procurement trends, Saudi stakeholders revealed that at present, other agencies are able to secure more favourable terms than the MOH. For example, the Ministry of National Guard Health Affairs (MNGHA), while responsible for a select subpopulation, brings pharmaco-economic analysis to the negotiation table. The MNGHA oversees five medical cities distributed across the country, which are home to prestigious evidence-based institutions often serving as higher-level referral centers. One of the organization's corporate P&T subcommittees has reportedly been undertaking pharmaco-economic analysis since 2014, working to adapt international and manufacturer-derived cost-effectiveness models to its local context. The MNGHA also operates its own Drug Policy and Economics Center.
Thus HTA capabilities have already begun to make headway in Saudi. Lack of expertise and resources having been the main limiting factors preventing more widespread adoption to date, our research with MOH stakeholders has revealed ongoing dialogue behind the scenes aimed at broader implementation in the public sector. While past proposals on the table have looked toward the lofty ambition of establishing a formal HTA center of expertise, the recent announcement appears to be more modest in scope, anticipated to take the form of an evaluation programme within the Ministry.
It is predicted that there will be an initial focus on new biologics and oncology medicines once the programme is up and running, as these have been targeted by policymakers as key areas of expenditure ripe for cost containment. In this context, policymakers are trying to better understand the processes used by NICE in the UK. Research is also being undertaken to consider a suitable cost-effectiveness threshold below which pharmaceutical products will be deemed cost-effective.
Nonetheless, the longer-term ambition among certain policymakers remains for Saudi to become a leading HTA reference centre regionally - and indeed one day further afield.
Posted 31 July 2015
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