Does India need a Health Technology Assessment Model? Which is the most appropriate one?

December 12th, 2018 - 0 Comments

An overwhelming 70% of all healthcare expenditures are met out-of-pocket in India, which is impoverishing a considerable number of its citizens. The government is paving a roadmap towards an improved healthcare scenario to upsurge the healthcare spend (% of GDP), restrain out-of-pocket expenditure, and improve access. Efforts are on to cut down the prices of numerous essential drugs through stringent price controls. Yet, this is not a sustainable solution in the long run. MNCs are increasingly hesitant to launch and capitalize their recent innovations in India. It is the need of the hour to quantify health economic outcomes for medical treatments because of the ever-increasing economic burden. There is a need to curate and execute an assessment method which is viable for the Indian circumstances and which addresses the multiple disciplines of Health Economics and Outcomes Research (HEOR).

The Department of Health Research has set up a body called Health Technology Assessment in India (HTAIn) to optimally utilize the available resources in a cost-effective manner. Presently, no substantial research associated with pharmacoeconomic assessment methods suited for India is in motion. There is a dire need to articulate standardized policies to curtail unnecessary expenditure and warrant superior quality healthcare throughout all socioeconomic classes.

We are witnessing diverse health technology assessment methods for pharmacoeconomic decision-making worldwide. It is virtually impossible for any country to simply incorporate other evaluation models into their healthcare system without a clear understanding of the feasibility. The following table displays the preferred assessment methods of some countries:

The table highlights Cost Utility Analysis as the most preferred assessment technique across developing countries. It is evident that every market has substantial differences and assessment methods are chosen on the basis of a set of factors including Regulatory Influence, Stakeholders, Budget, Economy etc.

Cost Utility Analysis is the most appropriate mode of assessment for the Indian healthcare system. It is designed to compare costs in financial units with outcomes in terms of their utility, typically to the patient, measured in Quality adjusted life years (QALYs). It is presumed that health is a function of ‘length of life’ and ‘quality of life’ and these are compiled into one figure called ‘QALY’. It is regarded as the most relevant metric of healthcare assessment due to its ability to appraise ‘Health’ and not just ‘Healthcare’ per se. The most noteworthy advantage of incorporating CUA is that it allows us to capture improvements in a patient’s condition throughout the medical intervention. The evidences required are real world as well as inexpensive to collect. It also enables us to compare the outcomes of a drug or a treatment with its available substitutes. For example, if a patient is suffering from angina, CUA can effectively be used to contemplate whether drugs or surgery should be the treatment modality. India being an emerging country with a huge population still striving for secured employment, the productivity of each citizen going through treatment must be restored to its maximum to ensure a steady income for a living.

The above analysis does not indicate that assessment methods apart from CUA are not good enough. Decisions should be made based on the economic impact that the method has on the overall healthcare system. There is a boundless incongruity in the quality and coverage of healthcare in India. The best solution to address this issue is to adopt a practical health technology assessment technique like CUA to leverage each available resource judiciously.

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