Evaluation of Health Technology Assessment in India

Grieve, E. , Gulliver, S., Mehndiratta, A., Tyagi, K., Baker, P. and Guzman, J. (2023) Evaluation of Health Technology Assessment in India. Diversity in Health Economics, 15th International Health Economics Association World Congress, Cape Town, South Africa, 08-12 Jul 2023.

Abstract

Background: Health Technology Assessment (HTA) helps decision-makers to understand the consequences of alternative courses of actions and to select the options that produce the best outcomes at the lowest cost. Institutionalisation of HTA is seen as pivotal to supporting Universal Health Coverage (UHC) as a means of supporting better allocation of finite resources, cost containment and the maximisation of health. An increasing investment in HTA in low- and middle-income countries has generated greater interest from policy makers about the value and return on investment (ROI) of HTA. Few studies have, however, quantified the benefits of HTA in terms of its value to the health system. The International Decision Support Initiative, a network of partners working with governments in health priority setting, has supported the institutionalisation of HTA in India (HTAIn). Established in 2017, the main purpose of HTAIn is to generate evidence to support Indian Central and State Governments to make more transparent, inclusive, and evidence-based decisions related to healthcare spending and prioritisation. Establishing HTAIn was an important milestone in India’s journey toward UHC. An impact assessment is important to support and advocate for ongoing investment in these processes. Aims: This evaluation aims to quantify the impact and the return on investment (ROI) achieved by HTAIn by reviewing a set of selected HTA studies commissioned by HTAIn between 2017-2021. Methods: A framework developed by University of Glasgow has been used to estimate the ROI in HTAIn taking into account the opportunity cost of investing in these processes. Net health benefits (NHB) are our measure of value in this quantitative framework. We calculated costs including the fixed costs for HTAIn and the costs for undertaking each HTA. Benefits were calculated by subtracting the counterfactual NHB (benefits that might have been realised without an HTA) from the current (modelled) NHB. The ROI is then calculated by aggregating the attributable benefits and offsetting these against the total costs. Results: Findings based on four case studies undertaken suggest investing in HTAIn yields a positive return. ROI is based on attributable benefits which we derive from realised benefits (actual implementation). Our findings show that investing in HTAIn yields a positive return of 10:1, with potential to increase to 71:1 with full implementation of recommendations. It is important to note that ROI is an aggregate of both health gains and financial costs i.e. it is not a typical cash return, with the ROI – in these case studies - driven by the value placed on the large health gains. Conclusions: While HTAIn requires financial investment, it is an efficient use of resources and offers value-for-money as a policy tool. To achieve impact on health outcomes and efficiencies it is essential that HTA evidence is translated to policy and effective implementation. Economies of scale and scope are also critical when considering the value of HTA at a systems level.

• Item Type: Conference or Workshop Item
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Grieve, Dr Eleanor
• Authors: Grieve, E., Gulliver, S., Mehndiratta, A., Tyagi, K., Baker, P., and Guzman, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment

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