Global HTA Landscape

United States

United States differs from many other developed nations in that it does not have universal health coverage, instead, the health care landscape is fragmented between federal, state, coporate health insurance and private insurances. I have to confess that as I began to write this section about the US health care landscape, I became so overwhelmed that I procrastinated by summarizing a number of other countries instead. Therefore, a more detailed discussion about this is forthcoming.

Likewise, health technology assessment in the US is fragmented between a number of federal agencies, insurers, and health care associations. At the federal level, Agency for Health Care Research and Quality (AHRQ) was founded to study the health effectiveness for managing common medical conditions. On the other end, recent rise of health care costs have also prompted many Health Maintenance Organization (HMO) to establish frameworks for determining coverage and effectiveness for various interventions.

Since the HMO reforms, multiple national organizations have proposed different value frameworks for cost effectiveness.

• Institute for Clinical and Economic Review (ICER)
• National Comprehensive Cancer Network (NCCN)
• American Society of Clinical Oncology (ASCO)
• American College of Cardiology and the American Heart Association (ACC-AHA)
• Avalere / FasterCures Patient-Perspective Value Framework (PPFV)
• Innovation and Value Initiative (IVI) Open-Source Value Project (OSVP)
• Memorial Sloan Kettering Cancer Center (DrugAbacus) The most popular among the various frameworks is the Institute for Clinical and Economics Review (ICER), which have received acknowledgement from Department of Veterans Affairs as well as private insurers such as CVS Caremark.

For the country's oldest and poorest patients, the Center for Medicare and Medicaid Service (CMMS) is responsible for the health technology assessment. In recent years, CMMS' Center for Medicare and Medicid Innovations have piloted new payment models and the experiments had been fruitful.

At the state level, there has been a number of interesting approaches to payment and coverage. For example, the state of Oregon adopted cost-effectiveness analysis that included residents' preferences to prioritize coverage determination. Meanwhile on the other side of the country, the state of New York have publicaly announced they will use ICER analysis as part of their Medicaid coverage decision-making.

Canada

Canada consists of 10 providences and 2 territories, and each of the providences is responsible for providing health services to its residents. Therefore, the Canadian health service delivery is highly decentralized between the different providences. In the 1990s, a coordinating office called Canadian Coordinating Office for Health Technology Assessment (CCOHTA) emerged nationally working alongside regional organizations from each providences. Since then, health technology assessment has been a collabroative effort between CCOHTA as well as a number of providences have established their own HTA agencies.

United Kingdom

United Kingdom has a nice framework for providing cost-effectiveness guidances, well, it's literally call NICE, the National Institute for Health and Care Excellence. NICE guidances use quality-adjusted life years (QALY) as the assessment tool for determing the benefits of a treatment intervention. Much have been written about NICE, but what better way than watching a BBC documentary on the topic.

Australia

The Australian Health Ministers Advisory Council (AHMAC) is the organizing body for health assessment, funding, while the 6 states and 2 territories is responsible for delivery of health services. In 1984, universal health insurance known as Medicare was passed and provides for the majority of funding and health services in Australia.

Version History

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• 01.03.22 Initial Draft