Ask not how but why, says UK collaboration architect

By Megan Brodie 2 weeks ago | In People, Reimbursement
  • 2 weeks ago

1 July 2024

An international collaboration of health technology assessment (HTA) agencies across four Commonwealth countries including Australia has the opportunity to improve on the European HTA collaboration by asking why work together before asking how, says Meindert Boysen, former NICE Head of International Affairs and a leading architect of the collaboration.

Boysen questioned the European choice to tackle more complex HTA submissions as first cabs off the rank for their Joint Clinical Assessment (JCA) initiative kicking off January 2025, saying that if the goal was to maximise efficiency of HTA processes across the 30 member states, they would tackle simple, straightforward submissions first.

The European process has become overly complicated due to challenges agreeing on PICOs (population, intervention, comparison, outcome), for example, meaning submission sponsors will need to provide varying information to each country involved in the HTA regulation.

Boysen says the so-called ‘Commonwealth consortium’ of the UK, Canada, Australia and New Zealand has the opportunity to take a different tac and, rather than first go to challenging submissions such as Alzheimer’s or gene therapies, instead collaborate on straightforward submissions aligned with their strategic imperative of delivering HTA guidance close to product registration.

“If the ‘why’ of collaborating is to make significant efficiency savings across the whole HTA system, let’s then focus on the 80 per cent of topics where the decision risk is relatively low, similar to NICE’s ‘proportionate approach’, by sharing cost comparison topics, for example,” Boysen told MedNews.

“This would leave the 20 per cent of really complex topics with high decision risk to the countries themselves. We should then spend time thinking about implementation, connecting the innovation with existing structures so that people can actually start benefitting early.

Boysen presenting at HTAi Seville.

“It’s so simple that it stares you in the face but people don’t go there because it’s not fancy or complicated.”

A new phase in his HTA career

Boysen last year took on the prestigious position of HTAi Global Policy Forum Chair. The Forum has been tackling some of HTA’s biggest challenges for 20 years, the chair’s role seeing him lead a group of senior leaders in the life sciences and HTA community.

He admits that on leaving NICE after more than two decades he felt “institutionalised” as working within the agency for so long restricted his ability to see the bigger picture.

“Having become an ever more integral part of the reimbursement arrangements for drugs in England, NICE’s focus on ‘volume’ and ‘speed’ risked losing sight of the very thing that made us who we are,” said Boysen.

“NICE is pretty unique in independently and transparently bringing together both scientific and social value judgements in decision-making, but in being part of any HTA organisation, it’s quite easy and tempting to become siloed in your thinking.

“The real benefit for me in leaving was that it allowed me to open my mind to a much broader perspective around HTA and what it means to a whole plethora of stakeholders, from patients to industry to consultancies to politicians.”

According to Boysen, HTA is all about “making the right connections with the right people” and since leaving NICE, his only firm commitment has been to the HTAi Global Policy Forum.

Started in 2004, the Forum consists of 19 for-profit and 19 not-for-profit organisations including pharma companies, HTA bodies and patient organisations and has a strong tradition of being a place where healthy debate around HTA policy can take place, its culture set by inaugural chair Chris Henshaw.

Boysen at HTAi asking experts why they do not first ask why when doing something, rather than what and how. Source: MedNews

“Chris organised the meetings in a way that built trust and allowed people to feel comfortable talking about things that classically may have been nerve racking for industry and HTA agencies,” explains Boysen. “A key part of that was the rules of engagement and the topics.”

The ever-evolving story of HTA

The Forum tackles one topic a year, this year’s being international collaboration and next year’s recently set as the impact of digitalisation and AI on HTA.

“We try and take topics that have a policy and strategic consequence for organisations, being careful not to miss the operational points as well,” Boysen explains.

“With AI, we can use it to make HTA processes more efficient, but do you use it, for example, as a tool to make decisions? Decisions are ultimately about humanity and human interaction, so where does AI begin and where does it end?

“The Forum is about meta stuff but the people in the room don’t just want to have a meta conversation. There is a sense of wanting to connect to something practical. That’s my job.”

Boysen took over the chair’s role from fellow HTA expert Dan Ollendorf and is now responsible for publishing the international collaborations paper, due shortly. The paper recommends HTA agencies ask why they are collaborating before asking how and what.

“With the Australia, Canada, NZ and UK collaboration, we went for the what and the how very quickly, but a couple of years in, people are asking why we are doing it? What is the problem we are trying to address? What is the impact we are likely to have?

“With AI, some people say we are too early while others say we are far too late as people are already making HTA submissions using AI. There’s billions and billions to be saved. People are thinking of an automated way of using data.”

In 2022, the Forum looked at life cycle HTA, concluding that agencies needed to make space for more complex and challenging submissions. NICE responded by introducing proportionate HTA, its intent being to spend 20 per cent of its assessment time on the 80 per cent of submissions that were relatively straight-forward (like cost-minimisation assessments) and 80 per cent of its time on submissions that challenged the HTA paradigm.

Meindert Boysen in Australia with his much-loved Akubra hat.

“HTA is an ever-evolving story where we are trying to get to a situation, whether through AI or modifier severity research or whatever else we can come up with, where 80 per cent of our appraisals are bog standard and reserve the rest for why we exist – to properly look at social value and scientific progress and not get bogged down by the commodification of HTA,” says Boysen.

As he carves out a space beyond NICE where he can contribute to the ever-evolving HTA story, Boysen says looking back he is concerned the export of NICE’s work through international collaborations fed a perception the organisation was “a prodigy or a gospel for how it has to be done” when in fact people like Boysen were trying to make it clear it was just the way they did it, unique to NICE’s story.

He said in collaborating, agencies needed to find the common ground without losing their individuality.

“Yes, there are very many things we can align on, share and collaborate, ensuring HTA remains a relevant and attractive approach to informing decisions across the world,” he said. “But, we must also make space for what matters most to each health system and society, and give this the time it deserves.”

©MedNews 2024

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