A researcher and postdoctoral fellow at the Institute for Health Economics, Policy, and Innovation (HEPII) will be teaching in the Applied Health Economics master's program at ECON MUNI starting this fall. He focuses on health technology assessment (HTA), which helps decide which drugs and medical devices will be covered by public health insurance. In this interview, he explains why HTA is key to modern healthcare and how it connects science, economics, and ethics.
In your research, you have long been involved in health technology assessment (HTA). Could you explain what this term means?
Health Technology Assessment is a multidisciplinary public health policy tool that analyzes the value of drugs, medical devices, or equipment. The goal of HTA is to contribute to evidence-based decision-making in health technology policy. HTA primarily evaluates the clinical benefits of new technologies and their cost-effectiveness.
What is the role of HTA in health economics and why is HTA relevant to ECON MUNI?
Economic aspects are currently the main drivers of decisions on whether or not to reimburse a drug. However, high-quality pharmacoeconomics requires a high-quality health economist, such as a graduate of ECON MUNI. That is why I see HTA as a very relevant topic for students. In HTA, their economic education can have a direct impact on decision-making and on the best possible distribution of a limited budget, thereby contributing to changing the world for the better. I find this very valuable and relevant.
Can you give a specific example of HTA use in the context of the Czech Republic, Slovakia, or Central Europe?
Let's take any example where a decision is being made about whether a new, expensive drug will be covered by public health insurance. First, its clinical benefit must be assessed, and then its value for money, i.e., its cost-effectiveness. In oncology, for example, a drug may improve quality of life and prolong it by several months. We must compare this benefit and the associated costs with the benefits and costs of currently reimbursed treatment over the patient's lifetime. Typically, only direct costs from the perspective of the healthcare payer are monitored.
The result of this pharmacoeconomic modeling (whether using Markov or micro-simulation models, for example) is then compared with the so-called willingness to pay. Most systems have an implicit or explicit willingness-to-pay threshold. The Czech Republic is willing to pay approximately CZK 1.2 million for one year of life in standardized quality (known as QALY).
HTA agencies analyze whether health technologies, such as medicines, meet this willingness to pay, thus supporting decision-making processes in individual countries. In the Czech Republic, this activity is carried out by a section of the State Institute for Drug Control, while in Slovakia it is carried out by the National Institute for Health Care Value and Technology.
What challenges does HTA bring?
HTA brings many challenges because it operates at the intersection of science and politics. It uses scientific methods to support decision-making processes that are ultimately political, and that is a challenge. In practice, this means that HTA assessments must be of high quality, as they are translated into practice, and at the same time they must be produced quickly, as all parties involved (patients, pharmaceutical companies, the ministry) are under time pressure. At the same time, HTA operates against a backdrop of sensitive ethical issues that we as a society often have not resolved. I am referring to issues such as the value of life or improving patient health. How can we distribute a limited budget fairly? Given that we cannot cover all needs, who should we give priority to? Cancer patients, patients with rare diseases, or pediatric patients? These are the issues behind HTA assessments, which we try to quantify in HTA analyses (if possible and helpful for decision-making) or otherwise process for decision-making processes.
You will also teach HTA in the Applied Health Economics master's program. What specifically will you focus on in your lectures?
I will focus on the theoretical background of HTA and also on practical questions of how HTA works, how the clinical benefit of technology is measured, and how it is converted into pharmacoeconomic modeling and decision-making with a primary focus on drugs.
