Editorial by HFE President John Bowis
When you need medical treatment, do you ever wonder why some products and services are available and others aren’t? Perhaps your friend in another country is able to get a treatment for a similar ailment that you can’t?
If you’ve ever wondered why, it is because even though healthcare technologies may receive approval to be sold in the EU, each Member State health system independently decides the level of reimbursement for the product – which impacts the accessibility to you as a patient. This process is called health technology assessment (HTA). An HTA might be a part of helping decision-makers determine the technologies, products and services that are offered by the health system. For drugs, following approval by the European Medicines Agencies, an HTA is used to support further price and reimbursement decision making.
The EU has been involved in supporting Member States on HTA for many years, mostly by co-financing joint actions to share best practices, work jointly on methodologies and having initial pilots of joint assessment on HTA (EUnetHTA) which might be further used at national level. However, with the implementation of the Patients’ Rights in Cross-border Healthcare Directive, the EU role in HTA is growing given the establishment of a permanent network to guide strategic decisions about cooperation at EU level – such as moving towards the development of joint HTAs to serve as input in multiple Member States in order to avoid duplication of work.
While the network can provide great benefits to health authorities by sharing information and providing support and complementary activities to national work, it is fundamental that the network ensure appropriate stakeholder involvement so that patient and healthcare professional views, as well as payer and industries expertise, is included in assessments. After all, the people who will use and benefit from technologies should be considered in the evaluation. This means developing a stakeholder involvement policy that secures stakeholder interests, and views, are taken into account before, during, and post decision-making processes on HTA. It is imperative that the network allow for an appropriate amount of stakeholder representatives to take part in the strategic direction of the network as well as individual HTA assessments.
I believe this is best achieved through the European Commission as Secretariat for the network precisely because the Commission is well-suited to managing stakeholder involvement in networks and expert groups. Its guiding principles and structure also help to safeguard transparency within the network and individual HTAs so that outcomes of joint evaluations can be understood, as well as the reasoning behind why certain technologies are, or are not, available to us in our healthcare system.
Of course, the EU will not be making decisions about which health technologies are reimbursed by Member State health systems, but it does play a very important role in guiding the decision-making processes of Member States on HTA. This is especially important as health systems throughout the EU look at ways to increase efficiency and efficacy of healthcare for all citizens. While HTA has an important part to play in supporting smart decision-making in healthcare, it can only do so via inclusive and transparent processes that ultimately consider all health stakeholders.