M3

• The role of HTA in the Philippines
• Entities using HTA in the Philippines

  • Philippine Health Insurance Corporation (PhilHealth)
  • Formulary Executive Council (Philippine National Formulary)
  • Department of Health (Universal Health Care Act)
• Universal Health Care Act


  Envisions to bring effective, efficient, accessible, affordable and quality healthcare to all Filipinos
• The use of health interventions and technologies within the national health care system should be based on rigorous assessments that follow common standards to ensure they bring value in improving health outcomes of Filipinos
• Higher demand leads to new health interventions and modernizations of health services
• The scope of HTA needs to expand to produce good quality evidence for emerging health technologies
• Different types of evidence on effectiveness, costs, and social preferences require different methodological standards to assess their potential value to the health care system
• The Five Pillars of Health System under the Universal Health Care Act


  • Financing
  • Service delivery
  • Regulation
  • Governance
  • Performance accountability
• Institutionalization of HTA


  • Improving financing and services through usage optimization of health technologies
  • Ensuring equitable access through the regulation of health products and services
  • Strengthening governance through evidence-informed policymaking
  • Contributing to performance accountability with its reassessment of the approved health technologies
• Equitable access to quality and affordable healthcare is achieved through a fair and transparent priority-setting mechanism and evidence-based financing and coverage decisions
• Legal and policy framework of HTA in the Philippines

  • RA 10606 National Health Insurance Act of 2013
  • AO 2016-0034 The New Implementing Guidelines of the Philippine National Formulary System
  • AO 2018-0026 Framework for the Use of HTA to Guide Coverage Decisions in Support of UHC
  • RA 11223 Universal Health Care Act
  • AO 2020-0041 The New Implementing Guidelines on Health Technology Assessment to Guide Funding Allocation and Coverage Decisions in Support of Universal Health Care
• PICOT


  Research questions formulated in Population-Intervention-Comparator-Outcome-Timeframe format
• Protocol development


  1. Research questions, objectives, and methods developed by assessment team

  2. Study protocol drafted with assistance of HTA Subcommittee members and relevant clinical experts

  3. Result of clinical assessment serves as basis for economic evaluation
• Economic evaluation (CEA and CMA)

  1. Cost-effectiveness analysis (CEA) conducted for health technologies with significant and meaningful clinical outcomes

  2. Cost-minimization analysis (CMA) conducted for health technologies with non-inferior or non-superior clinical benefits

  3. Economic evaluations include both CEA/CMA and budget impact analysis
• Economic evaluation (ELSI analysis)


  Analysis of ethical, legal, social, and organizational and health system implications to facilitate understanding of factors, issues, and barriers relative to the adoption of health technologies from the local perspective
• Health technologies found to be inferior to the comparator technology after clinical assessment stage shall not be recommended by the HTAC, and no further economic evaluation will be conducted
• General principles in the conduct of HTA

  • Ethical soundness
  • Inclusiveness and preferential regard for the underserved and unserved
  • Evidence-based and scientific defensibility
  • Transparency and Accountability
  • Efficiency
  • Enforceability
  • Availability of remedies and due process
• Health Technology Assessment Council (HTAC)

  • Created under Section 34.8 of the Universal Health Care Act
  • Overall role of providing guidance to the DOH and PhilHealth on the coverage of health interventions
  • Undertake technology appraisals by determining their clinical and economic values
  • Provision of financing and coverage
  • Oversee and coordinate the HTA process
  • Review and assess existing health technologies
• HTAC Core Committee composition

  • Public health epidemiologist
  • Health economist
  • Ethicist
  • Citizen's representative
  • Sociologist or anthropologist
  • Clinical trial or research methods expert
  • Clinical epidemiologist or evidence-based medicine expert
  • Medico-legal expert
  • Public health expert
• HTAC Core Committee


  Responsible for the development and submission of final recommendations to policy- and decision-makers
• Composition of HTAC Core Committee

  • public health epidemiologist
  • health economist
  • ethicist
  • citizen's representative
  • sociologist or anthropologist
  • clinical trial or research methods expert
  • clinical epidemiologist or evidence-based medicine expert
  • medico-legal expert
  • public health expert
• Chairman's Responsibilities


  • Preside over all HTAC meetings
  • Call meetings (through the HTA Technical Secretariat) to enable the HTAC to perform its duties and responsibilities
  • Take the lead in ensuring that the processes comply with the HTAC Process Guide
• Members' Responsibilities


  • Approve the agenda of the HTAC meetings
  • Ensure that the quality of the evaluations submitted by the Assessment Teams to the HTAC
• HTAC Subcommittees


  • Support the HTAC Core Committee in achieving a timely, effective, efficient and responsive technology appraisal process
  • Performing the initial review of HTA reports and submissions
• Types of Subcommittees


  • Drugs
  • Vaccines
  • Clinical Equipment and Devices
  • Medical and Surgical Procedures
  • Preventive and Promotive
• Subcommittee Composition


  • Minimum of one (1) and maximum of three (3) non-voting members for each subcommittee
• Subcommittee Chair Responsibilities


  • Preside over all meetings of their respective Subcommittees
  • Call meetings (through the HTA Technical Secretariat) to enable the Committee to perform its duties and responsibilities
  • Set the agenda for Subcommittee meetings in consultation with the Secretariat, and evaluate/approve requests for inclusion
  • Review, confirm, and sign the Subcommittee initial appraisal report/evidence summary
• Subcommittee Member Responsibilities


  • Exercise control over the expected quality, quantity, and timeliness of the HTA reports
  • Consider the submission and inputs from experts and patients
  • Evaluate the compliance of the Assessment Teams
  • Review and endorse the initial appraisal reports by the Committee to the HTA Core Committee
• Selection of HTAC Chair and Members

  1. Open nomination

  2. Competitive selection

  3. Deliberate recruitment

  4. Public call for nomination: to the academe, professional organizations as well as organized civil society and patient/consumer organizations

  5. The Secretary of Health appoints the Chair and members
• HTAC Term Limits


  • Each member: 3 consecutive terms only
  • 3 year term: all chair and members
  • 4 year term: only for medico-legal expert, ethicist, and the sociologist or anthropologist
• HTA Technical Secretariat


  • Provide the HTA Council with the necessary information and resources for discharging its duties
  • Conduct of needed orientation and training programs for newly appointed members of the HTAC
• Functions and Responsibilities of HTA Technical Secretariat

  1. Develop, review, and update the process guide

  2. Prepare the agenda of the HTAC Core and Subcommittee meetings

  3. Receive topic nominations from different stakeholders

  4. Ensure that all actions are accurately documented through audio recording and minutes of the meetings

  5. Plan, organize, control and set into operation the activities related to the conduct of meetings of the HTAC

  6. Take stock of past and existing HTAC decisions

  7. Prepare and store Committee/Subcommittee reports and summaries on recommendations

  8. Serve as the custodian of relevant documents and material

  9. Guide the HTAC on the rules of procedure and ensure fidelity

  10. Coordinate with health technology sponsors (for additional information or documents)
• HTA Policy Planning and Evaluation

  • Overall management of the health technology assessment and appraisal program
  • Development of normative guidelines and engagement with stakeholders at all stages of the appraisal
• Specific Functions of HTA Policy Planning and Evaluation

  1. Develop, review, update the Methods Guide

  2. Manage and deliver internal and external assessments

  3. Coordinate with health technology sponsors (for scoping and additional evidence needed in the assessment process)

  4. Produce and communicate technology appraisal reports

  5. Track the progress of appraisals

  6. Liaise with the Assessment Teams, expert and patient consultants and peer reviewers

  7. Manage all other HTA-related initiatives and projects

  8. Create the overall HTA strategic action plan
• Assessment Teams


  • Internal Assessment Team = HTA PPE Team
  • External Assessment Team = DOH and DOST-PCHRD
• Responsibilities of Assessment Teams

  1. Develop protocol for each assessment to be in line with the Process and Methods Guides

  2. Gather data needed by the HTAC Core Committee in the prioritization process

  3. Review the proponent's evidence submission and conduct preliminary assessment

  4. Conduct the appropriate assessment as determined by the HTAC Core Committee
• Other Participants in the HTA Process

  • Department of Health
  • Philippine Health Insurance Corporation
  • Food and Drug Administration
  • Philippine Institute of Traditional and Alternative Healthcare
  • Price Negotiation Board
  • Industry
  • Assessment Teams
  • Academe
  • Pool of Clinical Experts
  • Patient Organizations/Civil Society Organizations
  • Health Care Providers (i.e. hospitals, primary care providers, professional organizations)
  • Local Government Units (LGUs)
• Department of Health


  • Lead the health sector in the institutionalization of the HTA process
  • Development of policies and programs
  • Determination of a range of entitlements
• Philippine Health Insurance Corporation

  Design national health insurance benefit package and finance packages
• Food and Drug Administration

  Provide/share relevant clinical evidence with the HTAC on the safety and efficacy of medical products