Abstract
Capacity is limited in the developing world to conduct cost-effectiveness analysis (CEA) of health interventions. In Thailand, there have been concerted efforts to promote evidence-based policy making, including the introduction of economic appraisals within health technology assessment (HTA). This paper reviews the experience of this lower middle-income country, with an emphasis on the creation of the Health Intervention and Technology Assessment Program (HITAP), including its mission, management structures and activities.
Over the past 3 decades, several HTA programmes were implemented in Thailand but not sustained or developed further into a national institute. As a response to increasing demands for HTA evidence including CEA information, the HITAP was created in 2007 as an affiliate unit of a semi-autonomous research arm of the Ministry of Public Health. An advantage of this HTA programme over previous initiatives was that it was hosted by a research institute with long-term experience in conducting health systems and policy research and capacity building of its research staff, and excellent research and policy networks. To deal with existing impediments to conducting health economics research, the main strategies of the HITAP were carefully devised to include not only capacity strengthening of its researchers and administrative staff, but also the development of essential elements for the country’s health economic evaluation methodology. These included, for example, methodological guidelines, standard protocols and benchmarks for resource allocation, many of which have been adopted by national policy-making bodies including the three major public health insurance plans. Networks and collaborations with domestic and foreign institutes have been sought as a means of resource mobilization and exchange. Although the HITAP is well financed by a number of government agencies and international organizations, the programme is vulnerable to shortages of qualified research staff, as most staff work on a part-time or temporary basis.
To enhance the utilization of its research findings by policy makers, practitioners and consumers, the HITAP has adopted the principles of technical excellence, policy relevance, transparency, effective communication and participation of key stakeholders. These principles have been translated into good practice at every step of HTA management. In 2007 and 2008, the HITAP carried out assessments of a wide range of health products, medical procedures and public health initiatives. Although CEA and other economic evaluation approaches were employed in these studies, the tools and underlying efficiency goal were considered inadequate to provide complete information for prioritization. As suggested by official stakeholders, some of the projects investigated broader issues of management, feasibility, performance and socio-political implications of interventions. As yet, it is unclear what role HITAP research and associated recommendations have played in policy decisions.
It is hoped that the lessons drawn on the creation of the HITAP and its experience during the first 2 years, as well as information on its main strategies and management structures, may be helpful for other resource-constrained countries when considering how best to strengthen their capacity to conduct economic appraisals of health technologies and interventions.
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Notes
Exchange rate (mid 2007): Bt30 per $US1.
References
Neumann PJ. Using cost-effectiveness analysis to improve health care: opportunities and barriers. Oxford: Oxford University Press, 2005
Doherty J, Kamae I, Lee KKC, et al. What is next for pharmacoeconomics and outcomes research in Asia? Value Health 2004; 7 (2): 118–32
Iglesias CP, Drummond MF, Rovira J. Health-care decision-making processes in Latin America: problems and prospects for the use of economic evaluation. Int J Technol Assess Health Care 2005; 21 (1): 1–14
Tarn Y, Hu S, Kamae I, et al. Health-care systems and pharmacoeconomic research in Asia-Pacific Region. Value Health 2008; 11 Suppl. 1: S137–55
Tangcharoensathien V, Wibupolprasert S, Nitayaramphong S. Knowledge-based changes to health systems: the Thai experience in policy development. Bull World Health Organ 2004; 82: 750–6
Teerawattananon Y, Russell S. A difficult balancing act: policy actors perspectives on using economic evaluation to inform health-care coverage decisions under the Universal Health Insurance Coverage scheme in Thailand. Value Health 2008; 11 Suppl. 1: S52–60
The World Bank. Key development data and statistics [online]. Available from URL: (http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0,,contentMDK:20535285~menuPK:1192694~pagePK:64133150~piPK:64133175~theSitePK:239419,00.html) [Accessed 2009 Sep 26]
Tangcharoensathien V. National health account in Thailand. Alexandria (VA): Consultation on NHA and External Resource Flow for the Ellison Institute for World Health, 2005
IHPP. Thai NHA 2005. Current expenditure on health by function of care, providers and source of funding [online]. Available from URL: (http://ihpp.thaigov.net/NHA2002-2005/Thai%20NHA%202005.pdf) [Accessed 2008 Jul 12]
Ministry of Public Health. Thailand Health Profile 2001–2004. Nonthaburi: Ministry of Public Health, 2005
Teerawattananon Y, Tangcharoensathien V, Tantivess S, et al. Health sector regulation in Thailand: recent progress and the future agenda. Health Policy 2003; 63: 323–38
The Working Group for Drug Policy and Laws Study. National drug policy. In: Wibulpolprasert S, Chokevivat V, Tantivess S, editors. Thai drug system [in Thai]. Nonthaburi: International Health Policy Program, 2002
World Health Organization, Regional Office for South-East Asia. Health implications of the economic crisis in the South-East Asia region. Report of a Regional Consultation; 1998 Mar 23–25; Bangkok
Subcommittee for National List of Essential Medicine Development. Minutes of the Subcommittee meeting; 2008 Jan 30 [in Thai]. Nonthaburi: Food and Drug Administration, 2008
Wibupolprasert S. The need for guidelines and the use of economic evidence in decision-making in Thailand: lessons learnt from the development of the National List of Essential Drugs. J Med Assoc Thai 2008; 91 Suppl. 2: S1–3
Teerawattananon Y, Russell S, Mugford M. A systematic review of economic evaluation literature in Thailand: are the data good enough to be used by policy-makers? Pharmacoeconomics 2007; 25 (6): 467–79
Chaikledkaew U, Lertpitakpong C, Orrawattanakul Y, et al. Survey on the current human capacity and future needs in economic evaluation in Thailand [in Thai]. Nonthaburi: Health Intervention and Technology Assessment Program, 2008
Pitayarangsarit S, Tangcharoensathien V. Capacity development for health policy and systems research: experience and lessons from Thailand. In: Green A, Bennett S, editors. Sound choices: enhancing capacity for evidence-informed health policy. Geneva: World Health Organization, 2007: 147–66
Tomson G, Sundbom R. The Technology Assessment and Social Security in Thailand (TASSIT) project report. Stockholm: Division of International Health (IHCAR), Karolinska Institute, 1999
SPICE. Setting Priorities using Information on Cost- Effectiveness (SPICE): informing policy choices and health system reform in Thailand [online]. Available from URL: (http://www.moph.go.th/ops/spice) [Accessed 2008 Jun 2]
Tantivess S. Integrating IHPP research into policy decisions: 10th anniversary of the International Health Policy Program (19982008). Nonthaburi: International Health Policy Program, 2008
Nansunanont S, Tantivess S, Yothasamut J, et al. The development of health technology assessment in Thailand, 1996–2006 [in Thai]. Nonthaburi: Health Intervention and Technology Assessment, 2008
Tangcharoensathien V, Kamolratanakul P. Making sensible rationing: the use of economic evidence and the need for methodological standards. J Med Assoc Thai 2008; 91 Suppl. 2: S4–7
Tantivess S. Policy making and roles of health technology assessment. J Med Assoc Thai 2008; 91 Suppl. 2: S88–99
Hanvoravongchai P. Health system and equity perspectives in health technology assessment. J Med Assoc Thai 2008; 91 Suppl. 2: S74–87
Lertpitakpong C, Chaikledkaew U, Thavorncharoensap M, et al. A determination of topics for health technology assessment in Thailand: making decision makers involved. J Med Assoc Thai 2008; 91 Suppl. 2: S100–9
Health Intervention and Technology Assessment Program. Annual report 2008 [online]. Available from URL: (http://www.hitap.net/backoffice/report/reports_display2_en.php?id=171) [Accessed 2009 Jul 9]
Tangcharoensathien V, editor. Development of an optimal policy strategy for prevention and control of cervical cancer in Thailand. Nonthaburi: International Health Policy Program and Health Intervention and Technology Assessment Program, 2008 [online]. Available from URL: (http://www.hitap.net/index_en.php) [Accessed 2008 Nov 10]
Sauerborn R, Nitayarumphong S, Gerhardus A. Strategies to enhance the use of health systems research for health sector reforms. Trop Med Int Health 1999; 4 (12): 827–35
Macintyre S, Chalmers I, Horton R, et al. Using evidence to informhealth policy: case study. BMJ 2001; 322 (7280): 222–5
Health Intervention and Technology Assessment Program [online]. Available from URL: (http://www.hitap.net) [Accessed 2009 Sep 2]
Yothasamut J, Tantivess S. Management of health technology assessment in foreign countries [in Thai]. Nonthaburi: Health Intervention and Technology Assessment Program, 2008
Teerawattananon Y, Tantivess S, Yothasamut J, et al. Historical development of health technology assessment in Thailand. Int J Technol Assess Health Care 2009; 25 Suppl. 1: 241–52
Singer ME. Cost-effectiveness analysis: developing nations left behind. Pharmacoeconomics 2008; 26 (5): 359–61
Hailey DM. Health technology assessment in Canada: diversity and evolution. MJA 2007; 187 (5): 286–8
Jackson TJ. Health technology assessment in Australia: challenges ahead. MJA 2007; 187 (5): 262–4
Young J. Research and policy: parallel universe? London: Overseas Development Institute, 2003
Acknowledgements
This paper was developed as part of work under the Social Mobilization and Public Communication Plan of the HITAP. The programme was funded by the ThaiHealth, the HSRI, the Bureau of Policy and Strategy, Ministry of Public Health and the Thai Health-Global Link Initiative Project.
Yot Teerawattananon is leader of the HITAP and Sripen Tantivess is a researcher of this initiative.
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Tantivess, S., Teerawattananon, Y. & Mills, A. Strengthening Cost-Effectiveness Analysis in Thailand through the Establishment of the Health Intervention and Technology Assessment Program. Pharmacoeconomics 27, 931–945 (2009). https://doi.org/10.2165/11314710-000000000-00000
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DOI: https://doi.org/10.2165/11314710-000000000-00000