(For Audience) HTA 101 - Session 1 (02 Dec 2020) For Researchers and Academe

Session Objectives
1. Describe the organizational

structure and functions of HTA
Philippines
2. Describe how HTA helps national and

regional health systems achieve UHC
3. Describe how different stakeholders

can participate in HTA
HTA 101: Moving Together Towards UHC

Overview of HTA
in the
Philippines
Presented by:
Anna Melissa Guerrero, MD, MPH

(HTA)
HTA Unit Head

Overview of HTA in the Philippines
What are health technologies?
Any healthcare intervention used to promote health, to

prevent, diagnose or treat disease or for rehabilitation or long-
term care

Health Technology Assessment

HTA refers to the systematic
evaluation of properties, effects or
impacts of health technologies
developed to address a health problem
and improve quality of lives and health
outcomes.

Key Principles: Dimensions of

HTA
Clinical Economic
Efficacy, Safety, Efficiency, Costs,
Effectiveness, Indications, Cost-effectiveness,
Populations affected Cost utility, Cost
benefit
HTA
Patient Related Organizational

Social Impact, Ethics, Diffusion, De/centralization,
Acceptability, Accessibility, Skill-Routines,
Psychological Reactions Education-training
Reference: Bowen J.M., Patterson L.L., O'Reilly D., Hopkins R.B., Blackhouse G., Burke N., Xie F., (...), Goeree R.
Conditionally Funded Field Evaluations and Practical Trial Design Within a Health Technology Assessment Framework (2009) JACR Journal of the American College of Radiology, 6 (5) , pp. 324-331.

Sample Topics for Health Technology Assessment
Medicines to be listed in the Vaccines under the Health technologies/services funded

Philippine National Formulary National Immunization Program through DOH and Philhealth

Who does HTA in the

Philippines?
MARKETING APPROVAL ESSENTIAL MEDICINES LIST PURCHASING

Safety, efficacy and • Comparative effectiveness • Sustainability
quality • Costs/Cost-effectiveness • Equity
• Budget impact • Affordability
• Health service impact
• Equity/ethical/social implications
No structured and well-coordinated HTA framework for health interventions and technologies beyond drugs

Economic evaluations in the national

formulary
https://doi.org/10.1371/journal.pone.0131156 https://doi.org/10.1186/s12889-015-2046-1

Access to quality and

affordable healthcare and
health technologies
Competing public health Growing public demand for

priority concerns equitable health services

RA 11223 | Universal Healthcare Act

HTA under UHC Act

Key Stipulations
● Institutionalizing HTA as prerequisite for public financing and coverage
decisions of DOH and PhilHealth
● Creation of the Health Technology Assessment Council (HTAC) supported by
a unit with technical secretariat and policy planning and evaluation teams

HTA as a priority setting mechanism to guide coverage
decisions Priority Setting
Implementation Optimization
(Health Decisions
technology
management)
HTR
Monitoring Health technology
reassessment
&
Evaluation

HTA supports the health system in achieving UHC

through:
Transparency and Better resource

Priority setting Price negotiation
accountability allocation

Stakeholders – Healthcare
Multidisciplinary
providers, patients and public,
Researchers and Experts
industry
The HTA
System
Decisionmakers Technical Secretariat

Future Plans
● Establishment of the HTAC and the HTA Office
● Capacity building activities for HTAC, assessors, academic partners
● Creation of PHL reference costs for economic evaluations (2020)
● Development of methodological guides for priority HTs under UHC: medical
devices, orphan drugs, cancer drugs, medical/surgical procedures

The new implementing guidelines on HTA

The HTA
Administrative
Order
Presented by:
Katherine Ann Reyes, MD, MPP

HTAC Subcommittee on Preventive
& Promotive Health

The HTA Administrative Order
Administrative Order No. 2020-0041

Title
The New Implementing Guidelines on Health

Technology Assessment to Guide Funding Allocation
and Coverage Decisions in support of Universal
Health Care
Function
Sets HTA framework through the Process and

Methods Guides, identifies the roles and
responsibilities of stakeholders

The HTA Administrative Order Section V. B.
HTA Institutionalization
● DOH and PhilHealth coverage depend on
positive HTAC recommendations and
approval of Secretary of Health (SOH) DOH-NHP’s
Philippine National
CPG development and
Formulary system
● Aligns HTA with the processes of DOH and service delivery
PhilHealth
DOH-NIC’s National DOH Health Facilities
Immunization Program Enhancement Program
PhilHealth Benefit Package

Development

HTA Methods Guide
Criteria guiding HTAC

recommendations
Responsiveness to
magnitude, severity,
Interventions must address medical conditions
& equity placing the heaviest burden on the population

HTA Methods Guide

recommendations
Safety Best available evidence must show intervention to

and Effectiveness be safe and effective

HTA Methods Guide

recommendations
The intervention must be affordable and costs Affordability

must be viable to funding agents and Viability

HTA Methods Guide

recommendations
The intervention must provide overall gain to Cost

the health system and outweigh opportunity Effectiveness
costs

HTA Methods Guide

recommendations
The intervention must have economic Household

studies; Financial Impact
reduce out-of-pocket expenses

The HTA Administrative Order Section V. C.-D.,
M.
As new evidence arises, reviews and periodic

evaluations shall ensure that health
technologies funded by the DOH and PhilHealth
continue to add value to the health system.

The HTA Administrative Order Section V.
C-.D.
HTA Process and Methods Principles
Ethical Soundness Inclusiveness Scientific Defensibility Transparency
Efficiency Enforceability Due Process

The HTA Administrative Order Section V. N.-Q.
HTA implementation During Public Health Emergencies

The HTA Council may do expedited HTA
timeline upon the receipt of a written letter from
the Secretary of Health.
20 Feb 2019 10 Oct Oct 2019 Oct 2019-2021 Sept 2021 2024
2019
UHC Law UHC Law IRR HTAC Existing Tentative
(RA 11223) signed established health date to open HTA
signed thru UHC Act technologies new topic transition
rationalized nominations to DOST

The HTA Administrative Order PHEs Defined in RA 11223 (UHC Act)
Public Health Poses a high probability of any of the

following:
Emergency
Common causes:
1. Bioterrorism
2. Appearance of a novel or previously controlled or
eradicated infectious agent or biological toxin
Large number of deaths Large number of serious
3. A natural disaster in population injuries or long-term
disability
4. A chemical attack or its accidental release
5. A nuclear attack or accident
6. An attack or accidental release of
radioactive materials
Widespread or international Trade and travel restrictions
exposure to toxic substances

Decision-makers 3. FINAL DECISION
HTA Framework
● Secretary of Health
● DOH Executive Committee
● PhilHealth Board of Directors
HTA Council 2. RECOMMENDATION

Core
Committee
Clinical Medical and Preventive and

Traditional Other Health
Drugs Vaccines Equipment and Surgical Promotive
Medicine Technologies
Devices Procedures Health
Regular resource persons: 1. EVIDENCE GENERATION

FDA, PhilHealth, patient groups, HTA Unit
clinical experts ● Evidence generation
HTA Research Network
● Policy and planning
By-invitation resource
● Technical secretariat support
persons:
Reps from private sector and
HCPs

The HTA Administrative Order HTAC Core Committee
HTA Council Composition
Marita V. Tolentino Reyes, MD

Chair, Core Committee
Ma. Carmen Cornelia-Tolabing, DrPH Annabelle R. Borromeo, PhD, MHA, RN, CNS Maria Carinnes P. Alejandria, PhD
Public Health Epidemiologist Citizen’s Representative Social Anthropologist
Core Committee Vice Chair, Core Committee Core Committee
Bu C. Castro, M.D. Ll.B. FPSP Martha Bugnosen-Cayad–an, MD, MPH, CESO III Cecilia C. Maramba-Lazarte, MD, MScID, MScCT
Medico-Legal Expert Public Health Expert Clinical Trial/Research Methods Expert
Core Committee Core Committee Core Committee
Aleli D. Kraft, PhD Jacinto Blas V. Mantaring III, MD, MSc

Health Economist Clinical Epidemiologist/Evidence-based Medicine Expert
Core Committee Core Committee

The HTA Administrative Order HTAC Subcommittees
HTAC Subcommittees Preventive and Promotive Health
Limuel Anthony Abrogena, MD, FPAFP

Katherine Ann Reyes, MD, MPP
Luz Barbara Dones, MPH, RN
Drugs Clinical Equipment & Devices
Agnette Peralta, MSc Traditional Medicine

Noel Juban, MD, MSc
Lizette Kristine Lopez, MD Catherine Manuela Ramos, MSc
Marc James delos Santos, MD Isidro Sia, MD, PhD
Imelda G. Peña, RPh, DrPH
Gemiliano Aligui, MD, MPH, PhD
Martin Camara, DC
Vaccines Medical & Surgical Procedures

Other Health Technologies
Mediadora Saniel, MD, MBA-H Maria Minerva Calimag, MD, PhD

Iris Thiele Isip Tan, MD, MSc,
Jose Enrico Lazaro, PhD Joan Cristine Lareza, MD, FPOGS,
FPCP, FPSEDM
Mary Anne Roldan-Castor, MD, FPSUOG, FPSMS
Raymond Francis Sarmiento, MD
FPPS, FPSAAI Maria Isabelita Rogado, RN, MAN
Josefina Tuazon, RN, MN, DrPH

Health
Technology
Melissa Guerrero, MD,
Assessment MPH (HTA)
Head
Unit
As of October 2020
Jovy Veranda Jeff Madrona Jun Paculba
Admin Team Admin Team Admin Team
Sheena Samonte Yen Genuino-Marfori,

Lead for Tech Sec RPh, MSc
Team Lead for PPE Team
Norie Cagasan, Sab Aguinaldo, Maan Bermudez, Patty Encarnacion,

Raz Cabus, RND CJ Peradilla Marv Fajardo, MD
RND RPh MD RPh
Mica Policarpio, Nathan Solibaga, Sarah Obmaña,

Mico Ramos Bright Judan Lara Liban, RPh Ally Mondala, RPh
RPh RCh RPh
April Ocampo Arwin Onda, RPh Pau Panopio, RPh Mark Ramos
Yves Zuñiga,
Wincy Reyes Deinzel Uezono
FRSPH
The HTA Administrative Order Section V. B.
Technical resource persons
01 Non-voting relevant experts, stakeholders and

representatives
Regular resource persons from DOH, PhilHealth, FDA, PITAHC,

02 patient groups and clinical medicine experts
03 By-invitation from the private sector and health care

providers
Subject to the same Conflict of Interest (COI) disclosure and COI management requirements as
regular HTAC members

The HTA Administrative Order Section VI.
D.

A network of research partners shall be formed jointly by DOH and DOST to support
the activities of the HTA Unit.
The network aims

to:
01 Implement a research agenda related to HTA
Conduct trainings, workshops, and other activities to

02 build capacity in conducting assessments.

Roles and Responsibilities of

Offices

The HTA Administrative Order Section VII. | Roles &
Responsibilities
Decision Makers Partners
Office of the Secretary of Department of Science and Technology

Health
PhilHealth Board of Directors DOH - Health Regulation Team

The HTA Administrative Order Roles & Responsibilities
DOH Offices and Attached

Agencies
Input Data Process Planning
Epidemiology Bureau (EB)

Disease Prevention and Control
Legal Service (LS) Health Policy
Bureau (DPCB)
Food and Drug Administration (FDA) Development and
Price Negotiation Planning Bureau
Health Facilities Enhancement
Philippine Institute of Traditional and Board (PNB) (HPDPB)
Program (HFEP)
Alternative Health Care (PITAHC)

HTA Research
Networks
Presented by:
Jaime C. Montoya, MD, MSc, PhD, CESO
II Executive Director, Philippine Council for
Health Research and Development
Department of Science and Technology

Enabling Factors for Effective & Sustainable HTA

Network*
Shared Goals within the Clear governance Effective

structures Sustained resources communications support
Network
*Reference [WHO 2016: Key enabling factors in effective and sustainable research networks]

HTA Research Network Enabling Factors
DOST-PCHRD & HTA Philippines:

Partnership Objectives Shared
Goals
● Conduct capacity and platform-building

for regular HTA activities
● Develop a mechanism for implementing
health technology assessments efficiently

Expected role of research network members

Shared
Goals
● As institutions
○ Identify faculty and staff with HTA expertise
○ Oversee HTA studies being conducted by
constituents
○ Participate in periodic M&E activities
○ Develop short courses, post-graduate trainings
for HTA related disciplines

Expected role of research network members

Shared
Goals
● As individuals
○ Conduct studies pertinent to HTA
○ Participate in peer review
○ Submit reports on time

Stakeholder Roles and

Responsibilities Shared
Goals
Research Coordination and Evidence Generation
Technical Support
Health Technology Assessment Office Local and International Universities
Health Policy Development and Non-government research organizations

Planning Bureau (HPDPB)
DOST PCHRD Health Professional Societies

Framework for
collaboration Research
Quality
Assurance
HTAC DOST DOH
network
Governance
HPDPB and Structure
HTAO
International
NGO Local university
universities
Deliberation

How to be part of the HTA Research Network

Need to define:
● Minimum expertise of research groups
● Minimum standard methodology Governance
● Improvement of HTA methodology Structure
● Review process during monitoring and

evaluation
● Available resources for training programs
● Research dissemination platforms
● Affiliated in a research institution
with administrative and financial
support

How to be part of the HTA Research Network

What are the mechanisms on engaging public and private
institutions in the research network?
● Directed Call (COVID-19 Topics) Governance
Structure
● Pre-selected institutions will be contacted for research
● Open Call
● Publish list of available topics for research,
capable institutions will contact HTA
● Letter of Intent to be part of the cluster or consortium

COVID-19 Topics: Commissioning Process

List of topics Directed call
Research
HTAC AHEAD-HPSR DOH
Institutions
Research Quality
Institutions Assurance
Research HPDPB and

Sustained
Institutions HTAO
Resources
STA: 2 weeks
Complex: 2
months
Deliberation

Training Programs
● Plan to conduct HTA training programs
● Organize core trainers
› HTAC and International partners (HITAP, UK NICE)
● Plan to develop postgraduate training for HTA related disciplines

Sustained
Resources

Research Dissemination Plans

● Online HTA research repository
● Accessible to the public
● HTA website
Effective
Comms

COVID-19 research timeline and key

activities
Dec 2020 Jan 2021 Q1 2021 Mar 2021 Q2 2021
Submission of LOI Awarding of

Launching activity Target completion
Orientation activity Development of contracts and
& call for dates
TOR implementation
partners
STA: 2 weeks
Complex: 2
months

The significance of being an institutional

member of the HTA Research Network
● Expansion of the institutional faculty development program
● Broadening of the institutional research portfolio
● Recognition as a significant contributor to the attainment of universal
health care nationally and regionally
● Better appreciation of institutional relevance in national development

Best practices in organizing research

networks
Common interest and priority agenda Information sharing platforms
Aligned thrusts of the institutions Capacity building

activities
Established oversight mechanism Recognition for performing institutions

Common challenges in organizing research

networks
● Institutional commitment
● Individual commitment to promote network
● Lack of a common results framework
● Lack of joint activities among members
● Lack of alignment between funding and network
cycles
● Lack of donor’s interest to fund infrastructure

Key Takeaways
Collaboration strengthens the science

01 behind and practice of local HTA
Building an HTA research networks will help

02 multidisciplinary experts to work together and share
perspectives
Especially during PHEs, research networks will allow us to

03 quickly collect and share more data

The HTA Process
Guide
Presented by:
Limuel Anthony Abrogena, MD, FPAFP
Chair, HTAC Subcommittee on Preventive &
Promotive Health

HTA Process Guide Process Guide
Overview
What is the Process Guide?

● Reference document detailing:
○ HTA Governance Framework
○ General and Expedited HTA Process,
timelines
○ Important Forms and Templates
● Should be interpreted together with

the Methods Guide

HTA Process Guide
The HTA Process

Major Applications
Existing Health Technologies

● Currently financed by DOH and PhilHealth
General ● RA 11223 Sec 41(g) Transitory Provision
HTA Process
New Health Technologies
● Considered to be financed by DOH and PhilHealth
● RA 11223 Sec 6 Service Coverage

HTA Process Guide
The HTA Process

Major Applications
Expedited For all HTs considered for funding to address

HTA Process Public Health Emergencies (PHEs)

HTA Process Guide
The HTA Process

Major Applications
New HTs; not PHE but DOH and PhilHealth

priorities (4 Topics may be Urgent HTA Process
accepted per quarter) (for non-PHEs)

HTA Process Guide
The HTA Process

Major Applications Minor Application
Scope of Minor Inclusions

● Additional strength
● Additional packaging Minor Application
● Additional pack size/volume

HTA Process Guide Stakeholder role in the HTA process
flow
HTA Steps General Public Patients HCPs Policymakers Industry Researchers
Topic Nomination
Topic Prioritization
Scoping and Protocol Development

Legend
Assessment Topic
Proponent
Peer
Reviewer
Evidence Appraisal Assessor as part

of research
Recommendation network
Resolution Consultee
Decision Appellant
Dissemination Participant

HTA Process Guide Overview of HTA Processes
Final Week
General HTA Process Dissemi

nation
Week 57-128
Decision
Week 50-
125
Week 48-119 Resolution
Recommendation
Week 0-8 Week 8-24 Week 24-28 Week 28-111 Week 44-115
Topic Topic Scoping & Topic Evidence

Nomination Prioritization Protocol Assessment Appraisal
Development
Week 0-8 Week 1-13 Week 13-15 Week 15-16 Final Week
Topic Nomination Topic Evidence Appraisal Decision Dissemination

& Prioritization Assessment & Recommendation Expedited HTA Process

HTA Process Guide General HTA Process |
Algorithm
GENERAL HTA
PROCESS
HTAU Technical Scoping and

Topic Topic
Secretariat calls for Protocol
Nomination Assessment
topic nomination Development
Topic Prioritization
Evidence
Resolution Decision by SOH
Appraisal
Initial Recommendation Dissemination

HTA Process Guide General HTA Process | Step
1
TOPIC NOMINATION
Week 0-4
Who can nominate?
Submission of Topics
DOH Programs, PhilHealth, and other relevant stakeholders
Week 4-8
How can they nominate?
Checking for Compliance to Requirements
Accomplish documentary requirements specific to the
concerned health technology
Week 8-24
Comments on Shortlist
When can they start nominating?
September 2021

2
TOPIC
PRIORITIZATION
Week 8-24
How does HTAC prioritize topics?
Comments on Shortlist
HTAC screens topics based on prioritization criteria.
Week 8-9
What if the nominated topic was not prioritized?
Appeal for non-shortlisted topics
Proponents can undergo the 2-week appeals period.
What happens to topics that fail to meet these criteria? Week 24

Clarificatory meeting
Applications shall no longer proceed with the assessment and
will need to reapply as new topics.

3
SCOPING & PROTOCOL DEVELOPMENT, TOPIC ASSESSMENT,

EVIDENCE APPRAISAL, INITIAL RECOMMENDATION
Week 24-28
Key Participants Feedback to HTA Unit
Invited experts (e.g., Healthcare providers, Program
Managers, Patients)
Week 28-111
Assessment of dossier and formulation of analyses
*The HTA Unit defines the overall scope of technology
assessment (PICO) Week 44-115
- Peer review of Preliminary Assessment
- Public Consultation on acceptability and other social values
- Quality assurance of output and appraisal of result

7
RESOLUTION FROM HTAC &

DECISION OF THE SOH
Week 48-119
Key Participants Recommendation making
General Public, Patients, Healthcare providers, Hospitals
Policymakers, Industry, Researchers
Week 50-152
Receipt of appeals
*Stakeholders submit appeals to reconsider negative HTA
Council recommendation
Week 52-125
Screening and consideration of appeals

HTA Process Guide General HTA Process | Final
Step
DISSEMINATION
Facebook hta.doh.gov.ph Webinars

HTA Process Guide Overview of HTA Processes
Week 0-8 Week 1-13 Week 13-15 Week 15-16 Final Week
Topic Nomination Topic Evidence Appraisal Decision Dissemination

Expedited HTA Process
& Prioritization Assessment & Recommendation
Week 0-8 Week 8-24 Week 24-28 Week 28-111 Week 44-115
Topic Topic Scoping & Topic Evidence

Nomination Prioritization Protocol Assessment Appraisal
Development
Week 48-119
Recommendatio Week 50-125

n
Resolutio
Week 57-128
n
Decision
Final Week
General HTA Process
Dissemination

HTA Process Guide Expedited HTA Process |
Algorithm
EXPEDITED HTA
PROCESS Weeks 0-1
DOH National
Assessment
Secretary of Health Health Program HTAU Technical Topic
proceeds if
declares Public Director submits Secretariat receives Nomination
HTA Council
Health Emergency documents to documents &
approves
HTAU Prioritization
Topic
Assessment Decision by SOH
Dissemination
Evidence Appraisal and
Recommendation
Weeks 1-13 Weeks 13-15 Weeks 15-16

HTA Process Guide Expedited HTA Process | Rapid
Reviews
Rapid Reviews for COVID-19 HTs Guidance documents for the

implementers and users of
the health technology on the
minimum specifications
Rapid reviews serve as

● Rapid antigen test (15 Oct 2020) evidentiary basis for HTAC
recommendation
● Rapid antibody tests (31 July 2020)

● RT-PCR for COVID-19 diagnosis (18 May 2020)
● Extracorporeal membrane oxygenation (10 Sept 2020)
● Investigational drugs for COVID-19 (Apr 2020)
● AI-assisted diagnosis for COVID-19 (Mar, Apr 2020)
Access our COVID Rapid Reviews

hta.doh.gov.ph/assessments
Evidence summaries
present HTAC
recommendation on
specific HTs and how they
considered evidence

HTA Process Guide
Key Takeaways
● HTA involves collective effort across sectors
● PG ensures inclusiveness, transparency and accountability
1 HTA Process Guide ● HTA processes transform topics into action
● Evidence-based recommendations move PH closer to UHC
● Existing HTs (since October 2019) from DOH and PhilHealth

2 Current Annual HTA Process ● Expedited HTA Process (since March 2020, COVID-19)
● New HTs considered as DOH and PhilHealth priorities
3 HTA Processes in the works ● New HTA Processes (September 2021)

The HTA Methods
Guide
Jacinto Blas Mantaring III, MD, MSc
Clinical Epidemiologist/Evidence-based
Medicine Expert, Core Committee
Aleli Kraft, PhD

Health Economist, Core Committee
Maria Carinnes Alejandria, PhD

Sociologist/Anthropologist, Core
Committee HTA 101: Moving Together Towards UHC
The HTA Methods Guide:
Overview and Clinical
Assessment
Presented by:
Jacinto Blas Mantaring III, MD, MSc

Clinical Epidemiologist/Evidence-based
Medicine Expert, HTAC Core Committee

HTA Methods Guide Methods Guide
Overview
What is the HTA Methods Guide?

● Guides researchers in conducting HTA
● Reports generated inform how DOH and
PhilHealth allocate public funding and
resources

HTA Methods Guide General HTA Process | Recap of Topic Assessment
TOPIC
ASSESSMENT
Key Participants
● HTA Research Network

● HTA Unit Assessment Team
Week 28-111
Assessment of dossier and formulation of analyses
Option 1: Critical Appraisal of a submitted HTA by
the proponent
Option 2: Conduct of HTA (either by HTAU or commissioned
through the HTA research network)

Basic Methodological Initial PICOT
Framework of Topic
Assessment
Scoping
Final PICOT
Protocol
Development
Clinical
Assessment
Superior Non-inferior Inferior
Economic Assessment Ethical, Legal, Social, Economic Assessment Ethical, Legal, Social, Health Technology will
(Cost-effectiveness/Utility
and Health System (Cost-minimization Analysis + and Health System not be recommended
Analysis +
Budget Impact Analysis) Implications Analysis Budget Impact Analysis) Implications Analysis by HTAC
Basic Methodological Initial PICOT P Population
Framework of Topic
Assessment I Intervention
Scoping
C Comparator
Final PICOT O Outcome/s
T Timeframe
Protocol
Development
Clinical
Assessment
Analysis +
Budget Impact Analysis) Implications Analysis Budget Impact Analysis) Implications Analysis by HTAC
Framework of Topic
Assessment
Scoping
Final PICOT
Protocol
Development
Clinical
Assessment
Analysis +
Implications Analysis Budget Impact Analysis) Implications Analysis by HTAC
Budget Impact Analysis)
Framework of Topic
Assessment
Scoping
Final PICOT
Protocol
Development
Clinical
Assessment
Analysis +
Framework of Topic
Assessment
Scoping
Final PICOT
Protocol
Development
Clinical
Assessment
Analysis +
Economic Assessment
Presented by:
Aleli Kraft, PhD
Health Economist, HTAC Core Committee

HTA Methods Guide General HTA Process | Types of Economic
Evaluation
Cost Minimization Cost Effectiveness Cost Utility Analysis Cost Benefit Analysis
Analysis Analysis
Comparing costs to Measuring added cost Comparing costs per Comparing health and
determine least costly per extra unit of extra unit of health non-health benefits in
Refers to health technology health outcome benefit measured in terms money terms to cost
achieved of “utilities” or
quantity/quality of life
Equivalent or
Applied when clinical effect of
non-inferior to the Superior to the comparator
proposed technology is...
comparator
Cost expressed as Philippine Peso
Additional
Benefit expressed as Natural units Natural units Philippine peso
quantity/quality of life

HTA Methods Guide General HTA Process | Economic
Evaluation
Budget Impact Analysis

● Used to estimate how health interventions may impact funding over time
● Aims to increase awareness among DOH & PhilHealth policymakers, and aid
in budget or service planning
● Perspective: public payer

HTA Methods Guide
Philippine Reference Case for Health Economic

Evaluation
Decision Problem Perspective Comparator
Rationale of the study and Current standard of care or

Preferably publicly-funded
the policy question (PICO, most widely used
healthcare payer
setting, among others) intervention or no
comparator
Time Horizon Heterogeneity
● Lifetime horizon ● Effects and costs of HTs on

● Time horizon shorter than sub-populations
patient’s lifetime ● Relevant subgroups a priori

HTA Methods Guide

Evaluation
Measure of Health Outcomes Measure of Costs
Preferably expressed as utilities; quality-adjusted

life years (QALY):
● CEA/CUA: direct healthcare costs
QALY = Preferences for a health state X Time
in that state (Years) ● HFI: direct and non-healthcare costs
Disability adjusted life years (DALYs) may also be

acceptable if QALY is unavailable

HTA Methods Guide

Evaluation
Discounting Uncertainty
● Annual base case discount rate of 7%

(Ramsey Formula) ● Explore and quantify uncertainties through
● Decrease discount rate as time period increases appropriate sensitivity analyses
for time horizon greater than 30 years ● Deterministic Sensitivity Analysis
● Perform sensitivity analysis at 3 and 10% ● Probabilistic Sensitivity Analysis (PSA)
● Apply same rate to costs and benefits at a time

HTA Methods Guide General HTA Process | Economic
Evaluation
When are HTs considered “cost-effective” in the

Philippines?
01 02
Threshold for Cost or Non-Cost Effectiveness Other Decision Criteria
None currently in place; ICER thresholds from Responsiveness to magnitude, severity and
WHO often considered as guides equity; effectiveness and safety; household
financial impact; and, affordability and
viability

Ethical, Legal, Social and
Health Systems Impact
Assessments
Presented by:
Maria Carinnes Alejandria, PhD
Social Anthropologist,
HTAC Core Committee

HTA Methods Guide General HTA Process |
ELSHSI
Equity
Considerations
● Everyone receives fair opportunity to attain their full health
potential;
● No one disadvantaged from achieving said potential
● PROGRESS-Plus

ELSHSI
Equity
Considerations
● Everyone receives fair opportunity to attain their full health
potential;
● No one disadvantaged from achieving said potential
● Place of residence
● Race/ethnicity/ culture/language
● PROGRESS-Plus ● Occupation
● Gender/sex
● Religion
● Education
● Socioeconomic status
● Social capital
● Plus other factor possible
factors such as disease status or
disability

ELSHSI
Legal
Implications
● Consider relevant local and international laws on:
○ Health technology regulation (patent, market entry, off-label use, data protection,
product liability, etc)
○ Patient rights
○ Disease-specific laws and policies of relevant health sector agencies
● Consider using EUnetHTA ELSI checklist in assessing and reporting

ethical, legal, and social issues surrounding a proposed health technology

ELSHSI
Health Systems Impact

● Consider availability, feasibility or and capacity of human resources, service
capacity or facilities, and the potential to impact other roles of existing
divisions or organizations
● Conduct other qualitative methods (in-depth interviews, focus group
discussions, surveys) with DOH program managers, HCPs, LGUs, other
relevant stakeholders

HTA Methods Guide Expedited HTA Process | Recap of Topic Assessment
Topic Nomination
AO 2020-0041
In the event of a public health
emergency (as defined in the
Topic Assessment UHC Act-IRR), the HTAC may do
an expedited process of HTA.
Evidence Appraisal & Recommendation
RAPID REVIEWS
Follow systematic review
process (8-12 months) but
Decision by SOH
simplify its components;
1-3 months
Dissemination Khangura, 2012 (as cited in Dobbins, 2017)

HTA Methods Guide
Key Takeaways
HTA Methods Guide sets methodological standards that inform

01 the HTAC’s recommendations and decisions
Like the PG, the MG hinges upon inclusivity, transparency,

02 accountability
Sound recommendations rely on stakeholders with different fields

03 of expertise, such as clinical, economic, social

Have questions, concerns, or suggestions?
Contact us via email at [email protected]
or visit our website at hta.doh.gov.ph.

(For Audience) HTA 101 - Session 1 (02 Dec 2020) For Researchers and Academe

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Session Objectives

1. Describe the organizational

2. Describe how HTA helps national and

3. Describe how different stakeholders

HTA 101: Moving Together Towards UHC

Anna Melissa Guerrero, MD, MPH

HTA 101: Moving Together Towards UHC

What are health technologies?

Any healthcare intervention used to promote health, to

HTA 101: Moving Together Towards UHC

Health Technology Assessment

HTA 101: Moving Together Towards UHC

Key Principles: Dimensions of

Patient Related Organizational

HTA 101: Moving Together Towards UHC

Sample Topics for Health Technology Assessment

Medicines to be listed in the Vaccines under the Health technologies/services funded

HTA 101: Moving Together Towards UHC

Who does HTA in the

MARKETING APPROVAL ESSENTIAL MEDICINES LIST PURCHASING

HTA 101: Moving Together Towards UHC

Economic evaluations in the national

HTA 101: Moving Together Towards UHC

Access to quality and

Competing public health Growing public demand for

HTA 101: Moving Together Towards UHC

RA 11223 | Universal Healthcare Act

HTA 101: Moving Together Towards UHC

HTA under UHC Act

HTA 101: Moving Together Towards UHC

HTA 101: Moving Together Towards UHC

HTA supports the health system in achieving UHC

Transparency and Better resource

HTA 101: Moving Together Towards UHC

Decisionmakers Technical Secretariat

HTA 101: Moving Together Towards UHC

HTA 101: Moving Together Towards UHC

The new implementing guidelines on HTA

HTA 101: Moving Together Towards UHC

Katherine Ann Reyes, MD, MPP

HTA 101: Moving Together Towards UHC

Administrative Order No. 2020-0041

The New Implementing Guidelines on Health

Sets HTA framework through the Process and

HTA 101: Moving Together Towards UHC

PhilHealth Beneﬁt Package

HTA 101: Moving Together Towards UHC

Criteria guiding HTAC

HTA 101: Moving Together Towards UHC

Criteria guiding HTAC

Safety Best available evidence must show intervention to

HTA 101: Moving Together Towards UHC

Criteria guiding HTAC

The intervention must be affordable and costs Affordability

HTA 101: Moving Together Towards UHC

Criteria guiding HTAC

The intervention must provide overall gain to Cost

HTA 101: Moving Together Towards UHC

Criteria guiding HTAC