Around the world, governments are turning to the tools of Health Technology Assessment to guide their health care investment decisions. Faced with ageing populations and ballooning health care costs, governments need to ensure that they invest judiciously and specifically in technologies that can be demonstrated to be safe, effective and value for money.
This is especially relevant to Australia. A recent Australian Government report into Health Technology Assessment (HTA) recommended some significant changes to improve the efficiency of the processes of health technology assessment of diagnostic tests, medicines, medical devices, prostheses and surgical procedures. In some respects, however, it is clear that the government sees the evaluation and listing of medicines on the Pharmaceutical Benefits Scheme (PBS) as a model for other areas to follow.
As far as medicines are concerned, Australia can be regarded as having a mature HTA system. Since 1993, the Pharmaceutical Benefits Advisory Committee (PBAC) has required that both the relative clinical and cost-effectiveness of a medicine be demonstrated before it can be funded on the PBS. This is far from a straightforward task and it has been a strength of the Australian system that the government, the PBAC and the pharmaceuticals industry have been able to work together to ensure a consistent approach to the presentation and interpretation of clinical and economic evidence.
With maturity come challenges. Medicines are moving away from being simple chemical molecules that are expected to work equally well on all patients. The medicines in today’s R&D pipeline are more likely to be complex biological molecules, derived from our understanding of the genetic sciences, which are more tailored to the needs of individual patients. These can be difficult to develop, difficult to manufacture, and, potentially, high cost.
Australia needs to have a society-wide debate on how the government should continue to invest in such treatments. The evolving tools of HTA will play an important role in determining the value of such investment to the long-term health and economic well-being of Australia.
This conference is another example of how the Australian government and the medicines industry work constructively together to meet these challenges. Whilst the topics range widely across a number of subject areas, the unifying theme is that of value: how is it measured and what tools do we need to do it well? How are consumer values reflected in decisions to fund medicines? What is value for money for the government? and finally how will awareness of these issues shape the future of drug development itself?
Australia’s National Medicines Policy provides a useful framework within which to conduct such debates, the four objectives which are:
- timely access to the medicines that Australians need, at a cost individuals and the community can afford
- medicines meeting appropriate standards of quality, safety and efficacy
- quality use of medicines
- maintaining a responsible and viable medicines industry.
The challenge for all parties is to recognise the strong interdependency between these objectives and to work together to achieve the objectives of the National Medicines Policy.