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When health technology assessment is confidential and experts have no power: the case of Hungary

Published online by Cambridge University Press:  26 March 2018

Marcell Csanádi ,
Olga Löblová ,
Piotr Ozierański ,
András Harsányi ,
Zoltán Kaló ,
Martin McKee  and
Lawrence King
Marcell Csanádi*
Affiliation:
Doctoral School of Pharmacological and Pharmaceutical Sciences, University of Pecs, Hungary
Olga Löblová
Affiliation:
Department of Sociology, University of Cambridge, Cambridge, UK
Piotr Ozierański
Affiliation:
Department of Social and Policy Sciences, University of Bath, Bath, UK
András Harsányi
Affiliation:
Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary Department of Reimbursement, National Institute of Health Insurance Fund Management, Budapest, Hungary
Zoltán Kaló
Affiliation:
Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
Martin McKee
Affiliation:
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
Lawrence King
Affiliation:
Department of Economics, University of Massachusetts, Amherst, MA, USA
*
*Correspondence to: Marcell Csanádi, PhD student, Doctoral School of Pharmacological and Pharmaceutical Sciences, University of Pécs, 7624 Pécs, Honvéd u. 3, Hungary. Email: marcell.csanadi@syreon.eu
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Abstract

Health technology assessment (HTA) is not simply a mechanistic technical exercise as it takes place within a specific institutional context. Yet, we know little about how this context influences the operation of HTA and its ability to influence policy and practice. We seek to demonstrate the importance of considering institutional context, using a case study of Hungary, a country that has pioneered HTA in Central and Eastern Europe. We conducted 26 in-depth, semi-structured interviews with public- and private-sector stakeholders. We found that while the HTA Department, the Hungarian HTA organisation, fulfilled its formal role envisaged in the legislation, its potential for supporting evidence-based decision-making was not fully realised given the low levels of transparency and stakeholder engagement. Further, the Department’s practical influence throughout the reimbursement process was perceived as being constrained by the payer and policy-makers, as well as its own limited organisational capacity. There was also scepticism as to whether the current operational form of the HTA process delivered ‘good value for money’. Nevertheless, it still had a positive impact on the development of a broader institutional HTA infrastructure in Hungary. Our findings highlight the importance of considering institutional context in analysing the HTA function within health systems.

Type
Articles
Information
Health Economics, Policy and Law , Volume 14 , Special Issue 2: SPECIAL ISSUE: Frontiers of Health Policy Research , April 2019 , pp. 162 - 181
Copyright
© Cambridge University Press 2018 

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References

Banta, D. (2003), ‘The development of health technology assessment’, Health Policy, 63: 121–132.Google Scholar
Berntgen, M., Gourvil, A., Pavlovic, M., Goettsch, W., Eichler, H. G. and Kristensen, F. B. (2014), ‘Improving the contribution of regulatory assessment reports to health technology assessments – a collaboration between the European Medicines Agency and the European network for Health Technology Assessment’, Value in Health, 17: 634–641.Google Scholar
Bochenek, T., Kocot, E., Rodzinka, M., Godman, B., Maciejewska, K., Kamal, S. and Pilc, A. (2017), ‘The transparency of published health technology assessment-based recommendations on pharmaceutical reimbursement in Poland’, Expert Review of Pharmacoeconomics & Outcomes Research, 17(4): 385–400.Google Scholar
Böhm, K., Landwehr, C. and Steiner, N. (2014), ‘What explains “generosity” in the public financing of high-tech drugs? An empirical investigation of 25 OECD countries and 11 controversial drugs’, Journal of European Social Policy, 24: 39–55.Google Scholar
Boncz, I., Dozsa, C., Kalo, Z., Nagy, L., Borcsek, B., Brandtmuller, A., Betlehem, J., Sebestyen, A. and Gulacsi, L. (2006), ‘Development of health economics in Hungary between 1990-2006’, European Journal of Health Economics, 7(Supplement 1): 4–6.Google Scholar
Endrei, D., Molics, B. and Agoston, I. (2014), ‘Multicriteria decision analysis in the reimbursement of new medical technologies: real-world experiences from Hungary’, Value in Health, 17: 487–489.Google Scholar
Fischer, K. E., Rogowski, W. H., Leidl, R. and Stollenwerk, B. (2013), ‘Transparency vs. closed-door policy: Do process characteristics have an impact on the outcomes of coverage decisions? A statistical analysis’, Health Policy, 112: 187–196.Google Scholar
Guest, G. S., MacQueen, K. M. and Namey, E. E. (2011), Applied Thematic Analysis, Thousand Oaks, CA: SAGE Publications.Google Scholar
Gulácsi, L. and Pentek, M. (2014), ‘HTA in Central and Eastern European countries; the 2001: A Space Odyssey and efficiency gain’, European Journal of Health Economics, 15: 675–680.Google Scholar
Gulacsi, L., Boncz, I. and Drummond, M. (2004), ‘Issues for countries considering introducing the “fourth hurdle”: the case of Hungary’, International Journal of Technology Assessment in Health Care, 20(3): 337–341.Google Scholar
Gulácsi, L., Brodszky, V., Pentek, M., Varga, S., Vas, G. and Boncz, I. (2009), ‘History of health technology assessment in Hungary’, International Journal of Technology Assessment in Health Care, 25(Supplement 1): 120–126.Google Scholar
Gulácsi, L., Rotar, A. M., Niewada, M., Löblová, O., Rencz, F., Petrova, G., Boncz, I. and Klazinga, N. S. (2014), ‘Health technology assessment in Poland, the Czech Republic, Hungary, Romania and Bulgaria’, European Journal of Health Economics, 15(Supplement 1): S13–S25.Google Scholar
Henshall, C., Oortwijn, W., Stevens, A., Granados, A. and Banta, D. (1997), ‘Priority setting for health technology assessment. Theoretical considerations and practical approaches. Priority setting subgroup of the EUR-ASSESS Project’, International Journal of Technology Assessment in Health Care, 13: 144–185.Google Scholar
Huic, M., Tandara Hacek, R. and Svajger, I. (2017), ‘Health technology assessment in Central, Eastern and South European countries: Croatia’, International Journal of Technology Assessment in Health Care, 33(3): 376–383.Google Scholar
Inotai, A., Pekli, M., Jona, G., Nagy, O., Remak, E. and Kaló, Z. (2012), ‘Attempt to increase the transparency of fourth hurdle implementation in Central-Eastern European middle income countries: publication of the critical appraisal methodology’, BMC Health Services Research, 12: 332.Google Scholar
Jacob, R. and McGregor, M. (1997), ‘Assessing the impact of health technology assessment’, International Journal of Technology Assessment in Health Care, 13: 68–80.Google Scholar
Kaló, Z., Gheorghe, A., Huic, M., Csanadi, M. and Kristensen, F. B. (2016), ‘HTA implementation roadmap in Central and Eastern European countries’, Health Economics, 25(Supplement 1): 179–192.Google Scholar
Kaló, Z., Bodrogi, J., Boncz, I., Dózsa, C., Jóna, G., Kövi, R., Pásztélyi, Z. and Sinkovits, B. (2013), ‘Capacity building for HTA implementation in middle-income countries: the case of Hungary’, Value in Health Regional Issues, 2: 264–266.Google Scholar
Kani, C., Kourafalos, V. and Litsa, P. (2017), ‘Current environment for introducing health technology assessment in Greece’, International Journal of Technology Assessment in Health Care, 33(3): 396–401.Google Scholar
Kawalec, P. and Malinowski, K. P. (2016), ‘Relating health technology assessment recommendations and reimbursement decisions in Poland in years 2012-2014, a retrospective analysis’, Health Policy, 120(11): 1240–1248.Google Scholar
Kolasa, K., Dziomdziora, M. and Fajutrao, L. (2011a), ‘What aspects of the health technology assessment process recommended by international health technology assessment agencies received the most attention in Poland in 2008?’, International Journal of Technology Assessment in Health Care, 27: 84–94.Google Scholar
Kolasa, K., Kaló, Z. and Zah, V. (2016), ‘The use of non-economic criteria in pricing and reimbursement decisions in Central and Eastern Europe: issues, trends and recommendations’, Expert Review of Pharmacoeconomics & Outcomes Research, 16: 483–488.Google Scholar
Kolasa, K., Schubert, S., Manca, A. and Hermanowski, T. (2011b), ‘A review of health technology assessment (HTA) recommendations for drug therapies issued between 2007 and 2009 and their impact on policymaking processes in Poland’, Health Policy, 102: 145–151.Google Scholar
Kolasa, K., Kaló, Z., Zah, V. and Dolezal, T. (2012), ‘Role of health technology assessment in the process of implementation of the EU Transparency Directive: relevant experience from Central Eastern European countries’, Expert Review of Pharmacoeconomics & Outcomes Research, 12: 283–287.Google Scholar
Landwehr, C. and Boehm, K. (2011), ‘Delegation and institutional design in health-care rationing’, Governance, 24: 665–688.Google Scholar
Lavín, C. P., Alaniz, R. and Espinoza, M. (2017), ‘Visions of stakeholders about instutionalization of health technology assessment in Chile: a qualitative study’, International Journal of Technology Assessment in Health Care, 33(2): 303–306.Google Scholar
Löblová, O. (2016), ‘Three worlds of health technology assessment: explaining patterns of diffusion of HTA agencies in Europe’, Health Economics, Policy and Law, 11(3): 253–273.Google Scholar
Löblová, O. (2017a), ‘What has health technology assessment ever done for us?’, Journal of Health Services Research & Policy, doi: 10.1177/1355819617725545.Google Scholar
Löblová, O. (2017b), ‘Who’s afraid of institutionalizing health technology assessment (HTA)?: interests and policy positions on HTA in the Czech Republic’, Health Economics, Policy and Law, 13(2): 137–161.Google Scholar
Mandrik, O., Knies, S., Kaló, Z. and Severens, J. L. (2015), ‘Reviewing transferability in economic evaluations originating from Eastern Europe’, International Journal of Technology Assessment in Health Care, 31: 434–441.Google Scholar
Németh, B., Csanádi, M. and Kaló, Z. (2017), ‘Overview on the current implementation of health technology assessment in the healthcare system in Hungary’, International Journal of Technology Assessment in Health Care, 33(3): 333–338.Google Scholar
Oortwijn, W. J., Hanney, S. R., Ligtvoet, A., Hoorens, S., Wooding, S., Grant, J., Buxton, M. J. and Bouter, L. M. (2008), ‘Assessing the impact of health technology assessment in the Netherlands’, International Journal of Technology Assessment in Health Care, 24: 259–269.Google Scholar
Ozieranski, P. and King, L. (2016), ‘The persistence of cliques in the post-communist state. The case of deniability in drug reimbursement policy in Poland’, British Journal of Sociology, 67: 216–241.Google Scholar
Ozieranski, P. and King, L. (2017), ‘Governing drug reimbursement policy in Poland: the role of the state, civil society and the private sector’, Theory and Society, 46(6): 577–610.Google Scholar
Ozieranski, P., McKee, M. and King, L. (2012a), ‘Pharmaceutical lobbying under postcommunism: universal or country-specific methods of securing state drug reimbursement in Poland?’, Health Economics, Policy and Law, 7: 175–195.Google Scholar
Ozieranski, P., McKee, M. and King, L. (2012b), ‘The politics of health technology assessment in Poland’, Health Policy, 108: 178–193.Google Scholar
Rupel, P. V. (2017), ‘Current implementation of health technology assessment in healthcare system in Slovenia’, International Journal of Technology Assessment in Health Care, 33(3): 360–364.Google Scholar
Schumacher, I. and Zechmeister, I. (2013), ‘Assessing the impact of health technology assessment on the Austrian healthcare system’, International Journal of Technology Assessment in Health Care, 29: 84–91.Google Scholar
Szende, Á., Mogyorósy, Z., Muszbek, N., Nagy, J., Pallos, G. and Dózsa, C. (2002), ‘Methodological guidelines for conducting economic evaluation of healthcare interventions in Hungary: a Hungarian proposal for methodology standards’, The European Journal of Health Economics, 3: 196–206.Google Scholar
Valesco-Garrido, M. and Busse, R. (2005), Health Technology Assessment – An Introduction to Objectives, Role of Evidence, and Structure in Europe, European Observatory on Health Systems and Policies, Copenhagen, Denmark.Google Scholar
Voko, Z., Cheung, K. L., Jozwiak-Hagymasy, J., Wolfenstetter, S., Jones, T., Munoz, C., Evers, S. M., Hiligsmann, M., de Vries, H. and Pokhrel, S. (2016), ‘Similarities and differences between stakeholders’ opinions on using health technology assessment (HTA) information across five European countries: results from the EQUIPT survey’, Health Research Policy and Systems, 14: 38.Google Scholar
Yin, R. K. (2003), Case Study Research: Design and Methods: Volume 5 (Applied Social Research Methods), Thousand Oaks, CA: SAGE Publications.Google Scholar
Zechmeister, I. and Schumacher, I. (2012), ‘The impact of health technology assessment reports on decision making in Austria’, International Journal of Technology Assessment in Health Care, 28: 77–84.Google Scholar