Future HTA cooperation in Europe

This post is written by Davide Ruffo, Government Affairs Senior Manager, Public Affairs & Reimbursement, Eli Lilly and Company Italy.

I was recently at an event in the European Parliament that was literally standing room only. HTA experts, policy-makers, patients’ advocates and policy enthusiasts alike gathered to discuss the future of Health Technology Assessment (HTA) in Europe and to share national experiences. This just goes to show that EU HTA cooperation is set to be a key issue in Brussels in the coming months as EU institutions decide on the future of HTA beyond 2020. 

So how valuable is HTA cooperation at the EU level currently? HTA has become an effective policy tool in the quest to make health systems more efficient and to better allocate resources where appropriate. The ambition is to create a harmonised framework in Europe. However, the difficulty is that no two countries appear to be doing it in the same way, and the list of discrepancies can be rather long.

The current debate is focused on what needs to be harmonised and how it will be done in practice. European cooperation on relative efficacy (in other words, assessing the therapeutic benefit of new treatments) could have the potential to reduce work load, create efficiencies and enable more timely and equal access to innovative cures for patients across Europe. However, European level cooperation on relative effectiveness (meaning the comparative assessment of how the new technology performs in practice within a specific healthcare system) would not work in our view as specificities of local healthcare system and local, social, ethical and legal considerations are not transferable. It is the lack of transferability of such locally specific information that also means economic assessments are not transferable either.

In this sense, there is no "one size fits all" approach. EU HTA cooperation needs to be flexible enough to factor in ways in which a health technology can be used in a local context. For instance, in my home country, Italy, HTA is usually performed at a regional or local level. Moreover, HTAs are currently done on a voluntary basis and do not directly influence new treatments’ access to the market.

Could a transition period be envisaged until the system proves itself at EU level? MEP Françoise Grossetête (EPP, France) proposed that participation in a European HTA collaboration be voluntary, but implementation and uptake of joint work at national level be mandatory for those who do join. Many seemed to agree that decisions on pricing and reimbursement should remain a national competence to better answer local needs.

Last but not least, representatives from patient groups highlighted the need to have a process that is streamlined as much as possible to enable patients’ involvement.

The Commission will present a more detailed overview of the different submissions to the public consultation on how to strengthen EU cooperation on HTA by end of March 2017. This should help clarify the picture on the future of EU HTA – 2020 is just down the road after all!

Initial observations from the recent public consultation on HTA showed that there is consensus on the benefits of further cooperation. These responses should provide a good starting point towards creating a permanent structure that is usable, useful and pragmatic and works for everybody. Ultimately, it’s this that will influence the political will of the Member States to cooperate.