How HTA inform coverage 

How HTA inform coverage

decisions in Thailand

Yot Teerawattananon

Country and organizational profile
 Population: 67 millions
 Health expenditure: 5% of
Health expenditure: 5% of 
GDP (Public 70%)
 Establishment of the
Establishment of the 
Universal Healthcare Scheme 
in 2002 to compliment the 
Social Security Scheme and 
Civil Servant Medical Benefit 
Scheme

 HITAP
HITAP (2007): a research arm of the Bureau of Health 
(2007): a research arm of the Bureau of Health
Policy and Strategy, Ministry of Public Health
 Appraising a wide range of health interventions and 
pp g g
technologies including health promotion and public policy 2
 The National List of Essential Medicines (NLEM)
 Referred by three schemes as the pharmaceutical reimbursement
list
 The current version, contains 800
800+ drugs, was launch in 2010
 Pharmacoeconomic data was considered for the first time in the
selection of the MLEM in 2008 revision
Coverage
Drugs under consideration ICER (Baht/QALY) Year
decisions
pegylate interferon alpha 2b plus ribavirin for treatment of chronic
cost-saving Yes 2011
hepatitis C sybtype 145&6
pegylate interferon alpha 2a plus ribavirin for treatment of chronic
cost-saving Yes 2011
hepatitis C sybtype 145&6
lamivudine or tenofovir for treatment of chronic hepatitis B cost-saving Yes 2011

simvastatin for primary prevention of cardiovascular disease 82 000

82,000 Y
Yes 2009

Galantamine for treatment of mild-to-moderate Alzheimer's disease 157,000 No 2010

donepezil, rivastigmine for treatment of mild-to-moderate Alzheimer's
180,000-240,000 No 2010
disease
osteoporosis drugs (alendronate, residronate, raloxifene) for primary and
300,000-800,000 No 2009
secondary prevention of osteoporotic fractures
atorvastatin, fluvastatin. pravastatin for primary prevention of
negative dominant No 2009
cardiovascular disease
recombinant human erythropoietin (rHuEPO) treatment in chemotherapy-
chemotherapy
negative dominant No 2008
induced anemia
adefovir, entecavir, telbivudine, pegylate interferon alpha 2a for treatment
negative dominant No 2011
of chronic hepatitis B

17 Specific Working Groups for NLEM selection

- Reviewing evidences and generating evidence for ISafE scoring

The workingg group

g for coordination & consolidation of NLEM
- Gathering information and making recommendations to the subcommittee

2 weeks
The Subcommittee for Development of NLEM
- Setting criteria for drug selection and prioritizing those drugs for economic evaluation

6 weeks 6 weeks
the next round
Sustaining for 

Drugs listed on the top priority Drugs listed not on the top priority

The health economics The health economics

working group Drugs nominators working group
- Informing Non-profit organization - Rejecting to - Informing nominators to conduct
to conduct economic evaluation conduct the studies economic evaluation
6 weeks 20 weeks
Non-profit organizations 20 The health economics 20 Drug nominators
-Conducting economic weeks subgroup weeks -Conducting economic
evaluation studies by -Assessing quality of the evaluation studies by
precisely observing the economic evaluation studies precisely observing the
national HTA guidelines national HTA guidelines
6 weeks
k
Revising studies Revising studies
Need some revisions
Re‐conducting studies Re‐conducting studies
Unacceptable quality
Acceptable quality

4 weeks
The health economics working group
Considering those economic evaluation studies and developing policy recommendation

4 weeks
The working group for coordination & consolidation of NLEM
4
The Subcommittee for Development of NLEM
 List of drugs under HTA in 2012

 Bosentan, iloprost (Pulmonary Arterial Hypertension)

 G fiti ib erlotinib
Gefitinib, l ti ib (lung
(l cancer))
 Imatinib, dasatinib, nilotinib (CML)
 Imatinib, sunitinib (GISTs)
 Omalizumab (asthma)
 Trastuzumab (breast cancer)
 IVIg (PID and other immunomodulating condition)
 Coagulating factors (haemophilic bleeding, early bleeding treatment)
 Imiglucerase (Gaucher’s disease)
 Rituximab (haematologic disease)
 Sunitinib (renal cell carcinoma)

The UC benefit package development

6
Classification of interventions as per submissions by stakeholder groups
Stakeholders who submitted health topics
(number of submitted topics)
Total Selected
Interventions classification Policyy Health Healthcare Patient Layy topics
p topics
p for
makers Academics professionals Industry Civic groups associations citizens submitted assessment

(6) (5) (1) (6) (3) (3) (6) (30) (12)

Nature of interventions

Medicines* 4 2 - 4 1 1 - 13 5
Devices, equipment and supplies - - - 1 2 - 1 4 2
Medical and surgical procedures 1 - - - - 1 2 7 1
Organizational and managerial systems 1 3 1 1 - 1 3 11 4
Purposes of interventions

Prevention 1 - - - - - - 1 -
Screening and diagnosis †
- 1 1 1 - 1 3 7 3
Treatment 3 3 - 5 2 1 2 16 6
Rehabilitation 1 - - - 1 - - 2 2
C bi ti
Combination 1 1 - - - 1 1 4 1
Target disease of interventions

Non-communicable diseases 4 4 1 5 3 3 5 25 8
Communicable diseases 2 1 - 1 - - - 4 4
Both - - - - - - 1 1 -
Selected topics for assessment 4 3 1 2 1 1 - 12

The relationship between the assessment and the appraisal results

Recommended Not
Assessment results* Recommended
with restrictions recommended
ICER< 1 per Low
capita budget 2 2 1
GDP/QALY impact
High
budget 1 - 3
impact
ICER >1per Low
capita budget - - -
GDP/QALY impact
High
budget - - 1
impact

* Two cost analysis studies are not included in this table; High budget impact >THB 200 million
per annum; low budget impact ≤200 million per annum

ICER: Incremental Cost Effectiveness Ratio 8

1 capita GDP = 180,000 Baht
 Discussion
 HTA has been employed for resource allocation in 
Thailand through the NLEM and UC benefit package 
d l
development t
 Systematic and transparent way of setting priority on 
HTA t i
HTA topics are equal important to the assessment
li t t t th t
 Local data is vital for HTA use, esp. for the benefit 
package de elopment the need for ser ice model
package development—the need for service model 
development as well as feasibility studies