Talent Culture in Health Technology Assessment: A Survey of Experts | BMC medical training


Health technology assessment has become increasingly important in many countries in recent years [8], and the demand for HTA professionals has increased in universities, governments and industries. So far, there has been little research on HTA talent cultivation in Taiwan or Asia. We hope that the results of this study will provide useful information for HTA trainers and educators.

One of the ultimate goals of training and education is to develop the skills of students required by the jobs involved. We found that among academic, government, and industry positions, pharmacoeconomics and other courses were perceived as the most important and useful of all the courses assessed. Indeed, analytical methodologies and skills such as cost-benefit and budget impact analyzes are essential for conducting HTAs. [9]. Even so, HTA is a multidisciplinary process that involves different types of analysis and considers multiple aspects of the implications (including ethical, legal and social) [10] to inform reimbursement or health policy decisions. Thus, conducting an HTA or designing an HTA training program should also include political and sociocultural perspectives on health technologies. Additionally, during the process of generating and using HTA evidence, future HTA agents will also need management, coordination and communication skills. [11].

Study results and written feedback from respondents also suggest that our TMU HTA program can be improved by: (1) incorporating courses that provide students with the knowledge and skills to perform assessments (systematic reviews, meta -analysis and analysis of large databases) then write professional HTA reports; (2) include other optional modules that can also enhance HTA skills, such as healthcare system and policy, survival analysis, Bayesian thinking, pharmacoepidemiology, and healthcare financing health ; (3) provide opportunities to broaden and deepen the scope of students’ HTA learning by incorporating experiences such as internships at HTA-focused institutions.

As the importance and use of ETS increases, different organizations have attempted to discuss and delineate the skills required by ETS professionals. For example, in 2014, the International Network of Health Technology Assessment Agencies (INAHTA) held a workshop on current experiences in HTA capacity building. Some essential technical/scientific skills (e.g., research and critical appraisal of literature, statistics, economic analysis) and soft skills (e.g., management, writing, interaction with team members, consensus building) were identified by workshop participants. [12]. As a follow-up, Mueller and colleagues conducted four interrelated research activities (including manual/toolkit reviews, workshops, and surveys via questionnaires) between 2016 and 2019 and identified a list of skills needed to the ETS. [13]. Currently, HTA curricula in educational institutions around the world are diverse and consensus on core competencies is still being established among stakeholders involved in HTA. We hope that our experience with the TMU HTA program and the results of this study will contribute to the existing literature and also provide useful insights for future HTA talent cultivation.

Given resource constraints, economic evaluations on whether to adopt a new health technology or abandon an old one in the health care system have become an integral part of the resource allocation decision-making process. Budget impact analysis (BIA) and cost-effectiveness analysis (CEA) are thus increasingly required by health sector authorities before reimbursement or approval of the form. Currently in Taiwan, when applying for National Health Insurance reimbursement, manufacturers are required to provide budget impact analyzes on new drugs and medical devices, but pharmacoeconomic evaluations are optional. However, in order to advance hypertension in Taiwan, manufacturers are encouraged to conduct local pharmacoeconomic analyzes to obtain a price markup of up to 10%. While the BIA assesses affordability, the CEA assesses value for money. The resources required to conduct a CEA and its level of complexity are certainly not inferior to those of a BIA, and are very likely superior to them. Nevertheless, as our results indicate, HTA experts, particularly those from the industrial sector, believe that the government gives more importance to the BIA than to the CEA, which is a difficulty, and probably a disappointment, to which they are faced.

Our survey revealed that the lack of local data is a major challenge for the ETS, and this has also been observed in other countries, such as India and those in Latin America. Rosselli et al. reported that the limited availability of local data was a barrier to conducting HTA in Latin America [14]. Indeed, most survey respondents recognized the crucial role of local data in implementing ETS and were willing to invest in local databases. Additionally, Downey et al. found that in India there was a significant lack of some local data needed to conduct an HTA, particularly data related to cost, service utilization and quality of life [15]. Because the ETS is country-specific, ETS proponents will need to fill local data gaps in each country. Governments should do more to encourage and support academic and industrial institutions to generate local data on costs, epidemiology and health utility. In addition, standardization and transparency of data collection mechanisms should be established.

There are several limitations to this study. First, although reminder emails were sent twice, the response rate was not satisfactory. Second, despite our efforts to seek out experts in HTA-related fields and the vast experience of those who responded (an average of 11.3 years of relevant professional experience), the results of the study did not may not represent the opinions of all ETS experts.

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