What kind of HTA does the US need?

Should the US have a formal, centralized health technology assessment (HTA) organization? In the United Kingdom, the National Institute for Health and Care Excellence (NICE) plays this roles and has a significant impact on drug pricing in the UK. However, the UK relies on a single payer system and NICE’s recommendations can be directly implemented into the National Health Service (NHS) coverage recommendations and price negotiations. Would such an organization work in a decentralized system like the U.S?

A white paper from the USC Schaeffer Center, argues that an HTA coordinating body–which they name Institute for Health Technology Assessment (IHTA)–could serve this purpose. The authors argue that IHTA could supplement–but not replace–private HTA activities by groups such as ICER, IVI, pharmaceutical manufacturers, and payers. The panel argues that shifting some funding from the private to the public sector, there may be some cost savings due to a reduction of duplicative multiple efforts within the current HTA ecosystem. The panel offers 6 recommendations for how IHTA could be implemented.

• Recommendation 1: Private HTA efforts should be encouraged.
• Recommendation 2: The U.S. should establish a publicly funded HTA coordinating entity, the Institute for Health Technology Assessment (IHTA), to support HTA beyond individual private efforts and to evaluate the quality of HTAs conducted by such organizations
• Recommendation 3: IHTA-conducted and -approved reports should include an economic evaluation with findings presented in a disaggregated format.
• Recommendation 4: HTA should be conducted across a broad array of technologies and healthcare services—new and old—including drugs, devices, diagnostics, procedures and public health interventions.
• Recommendation 5: A stakeholder engagement process should provide input to the priorities and activities of the IHTA.
• Recommendation 6: The U.S. should implement policies that allow an advisory-only HTA organization to have an impact on decision-making.

A key issue is how much power such an IHTA body would have. The panel argues that IHTA would be advisory at first. “CMS be required to consider (but not required to use) IHTA reports in its Medicare coverage decisions.” The IHTA idea may best balance the need for HTA oversight and coordination with allowing for a diverse set of private HTA to continue to function within the U.S.’s current, decentralized health care system.

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