Adaptive health technology assessments to inform oncology based priority setting in India

Background Health technology assessment (HTA) is a valuable tool for informing the most efficient allocation of resources, yet is highly resource intensive limiting its applicability in practice. Adapting the HTA process by leveraging available international evidence offers a pragmatic solution to such challenges, saving time whilst still generating useful insight for decision making. Objective To develop an adaptive HTA (aHTA) framework that could be used to assess the likely cost-effectiveness of cancer treatments to inform the available entitlements under the Indian national health insurance scheme. Methods The International Decision Support Initiative worked with the National Cancer Grid in India to develop an aHTA framework which included topic selection, scoping, evidence review and appraisal to estimate the likely cost-effectiveness of cancer interventions. The evidence included international data on cost effectiveness (HTA reports and economic evaluations), price benchmarking and treatment cost estimates. Ten interventions were assessed with the newly developed framework by a working group of clinicians and health economists from both institutions. Results Of 10 interventions assessed, 9 had sufficient evidence to decide cost-effectiveness; 3 were cost-effective (1 only after a discount, 1 using the generic price), 5 were not and 1 was not cost-effective for all but was in a subgroup. A full HTA was recommended for one intervention due to uncertainty. Information on the likely cost-effectiveness, clinical benefits and treatment costs was consistently available through publicly available evidence. India on average paid almost 4 times the list price of other countries. Conclusion aHTA provides an alternative to using no economic evidence at all if a full HTA cannot be conducted. It is well-suited to cancer drugs for which there is ample available international information on cost-effectiveness. Our framework quickly generated consistent, transparent evidence to inform guidelines. The approach may be replicable in other settings in supplement to full HTA. Key messages What is already known on this topic There is an enormous need for more evidence informed priority setting, however there are often significant challenges to doing so such as insufficient data, capacity and resources available. Some countries are exploring the use of rapid or adaptive methods of health technology assessment (HTA) but there is no clear guidance on the methodology that should be used. What this study adds Experience of the results of an adaptive HTA framework in practice, based on 10 oncology problems. How this study might affect research, practice or policy Other countries or institutions with limited capacity for HTA could potentially use the framework to perform their own adaptive HTA assessments.