The Role of the National Health Insurance Fund Administration in the Development of Health Economics and Health Technology Assessment in Hungary

Abstract

We read with great pleasure ISPOR’s new journal, Value in Health Regional Issues, which had been devoted to the regions of Central and Eastern Europe, Western Asia, and Africa (CEEWAA) [[1]Boncz I. Kalo Z. Mohamed Izham M.I. Greenberg D. Further steps in the development of pharmaco-economics, outcomes research and health technology assessment in Central and Eastern Europe, Western Asia and Africa.Value Health Regional. 2013; 2: 169-170Abstract Full Text Full Text PDF Scopus (30) Google Scholar]. We do believe that ISPOR’s strategic decision on releasing this journal and providing space for scholars from less developed regions of the world for publishing their findings in the field of health economics and outcomes research is an excellent way for disseminating scientific outputs throughout these regions. The first CEEWAA issue of Value in Health Regional Issues provided a well-balanced overview of current research trends, capacity building, and health policy aspects of countries of the CEEWAA region. Kaló et al. [[2]Kaló Z. Bodrogi J. Boncz I. et al.Capacity building for HTA implementation in middle income countries: the case of Hungary.Value Health Regional. 2013; 2: 264-266Abstract Full Text Full Text PDF Scopus (41) Google Scholar] gave an excellent overview on the capacity building for health technology assessment (HTA) implementation in middle-income countries describing the case of Hungary. Our aim is to give a short overview on the role of the National Health Insurance Fund Administration (Országos Egészségbiztosítási Pénztár [OEP]) in the development of health economics and HTA in Hungary. A more detailed description of the Hungarian health care system can be found elsewhere [3Gaal P. Szigeti S. Csere M. et al.Hungary health system review.Health Syst Transit. 2011; 13: 1-266PubMed Google Scholar, 4Boncz I. Nagy J. Sebestyen A. Korosi L. Financing of health care services in Hungary.Eur J Health Econ. 2004; 5: 252-258Crossref PubMed Scopus (80) Google Scholar, 5Boncz I. Sebestyen A. Financial deficits in the health services of the UK and Hungary.Lancet. 2006; 368: 917-918Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar, 6Boncz I. Dozsa C. Kalo Z. et al.Development of health economics in Hungary between 1990-2006.Eur J Health Econ. 2006; 7: 4-6Crossref Scopus (27) Google Scholar, 7Betlehem J. Boncz I. Kriszbacher I. et al.The export of nurses from Europe to the United States.Am J Public Health. 2007; 97: 2119Crossref PubMed Scopus (4) Google Scholar, 8Szócska M.K. Réthelyi J.M. Normand C. Managing healthcare reform in Hungary: challenges and opportunities.BMJ. 2005; 331: 231-233Crossref PubMed Scopus (9) Google Scholar, 9Kriszbacher I. Olah A. Bodis J. Boncz I. Health sciences research in Hungary.CMAJ. 2007; 176: 809-812Crossref PubMed Scopus (8) Google Scholar, 10Boncz I. Sebestyen A. Health services research in Hungary.Med J Australia. 2006; 184: 646-647PubMed Google Scholar]. The introduction of health economics and HTA into decision making started in Hungary in to 2001 when a nationwide public health program was developed. An important part of that complex public health initiative was the introduction of organized, nationwide cancer-screening programs for breast and cervical cancer. To explore the cost and benefits of such programs, a primary health economics analysis was performed by the working group of the National Health Insurance Fund Administration (OEP), the only health care financing agency in Hungary [11Boncz I. Sebestyén A. Pál M. et al.Health economics analysis of cervical cancer screening.Orv Hetil. 2003; 144: 713-717PubMed Google Scholar, 12Boncz I. Sebestyén A. Gulácsi L. et al.Health economics analysis of breast cancer screening.Magy Onkol. 2003; 47: 149-154PubMed Google Scholar]. The cost-effectiveness analysis of breast cancer [[13]Boncz I. Organized nationwide breast cancer screening programme was introduced in Hungary in 2002.Swiss Med Wkly. 2006; 136: 328PubMed Google Scholar] and cervical cancer [[14]Boncz I. Prevention of cervical cancer in low-resource settings.JAMA. 2006; 295: 1248Crossref PubMed Scopus (24) Google Scholar] found that both programs are cost-effective in Hungary from a purchaser’s point of view. After the evaluation of medical and economic considerations, an organized, nationwide breast and cervical cancer screening program was introduced in Hungary in 2002 and 2003, respectively [15Boncz I. Sebestyen A. Dobrossy L. et al.The organization and results of first screening round of the Hungarian nationwide organised breast cancer screening programme.Ann Oncol. 2007; 18: 795-799Crossref PubMed Scopus (30) Google Scholar, 16Boncz I. Sebestyen A. Ember I. Organized, nationwide cervical cancer screening programme in Hungary.Gynecol Oncol. 2007; 106: 272-273Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar]. These screening programs represent the first case in Hungary when the health care financing authority (OEP) performed a formal health-economics analysis for the assessment of costs and benefits of a new medical technology and the results of cost-effectiveness analysis were considered during the decision-making process. After the introduction of the screening program, a monitoring process has been developed for continuous evaluation of the implementation of the program. The results of the monitoring process have also been published in international scientific literature and presented at ISPOR congresses [17Vokó Z. Nagyjánosi L. Margitai B. et al.Modeling cost-effectiveness of cervical cancer screening in Hungary.Value Health. 2012; 15: 39-45Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 18Kovács A. Döbrössy L. Budai A. et al.Cervical screening in Hungary: why does the “English model” work but the “Hungarian model” does not?.Eur J Gynaecol Oncol. 2008; 29: 5-9PubMed Google Scholar, 19Boncz I. Sebestyen A. Pinter I. et al.The effect of an organized, nationwide breast cancer screening programme on non-organized mammography activities.J Med Screen. 2008; 15: 14-17Crossref PubMed Scopus (22) Google Scholar, 20Boncz I. Sebestyen A. Pinter I. et al.Age-group specific gap between treatment cost of and mortality due to breast and colorectal cancer.J Clin Oncol. 2007; 25: 4501-4502Crossref PubMed Scopus (17) Google Scholar]. The cost-effectiveness of colorectal cancer screening was also evaluated by the National Health Insurance Fund Administration (OEP): simultaneous application of both the guaiac-based test and the immunochemical fecal occult blood test detecting hemoglobin and albumin was compared with the no-screening strategy [[21]Boncz I. Sebestyén A. Dózsa C. et al.Health economics analysis of colorectal screening.Magy Onkol. 2004; 48: 111-115PubMed Google Scholar]. Colorectal cancer screening proved to be cost-effective in the Hungarian setting [[22]Boncz I. Sebestyen A. Dobrossy L. Otto S. The role of immunochemical testing for colorectal cancer.Lancet Oncol. 2006; 7: 363-364Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar]. A small area pilot colorectal cancer screening project was introduced in the town of Ajka and surroundings in 2003 to 2004, and further monitoring was also conducted, but a nationwide colorectal screening program was still not introduced in Hungary [23Csonka C. Molnár C. Németh M. Ottó S. Results of and experinces with colorectal screening in town Ajka.Magy Onkol. 2004; 48: 29Google Scholar, 24Boncz I. Brodszky V. Péntek M. et al.The disease burden of colorectal cancer in Hungary.Eur J Health Econ. 2010; 10 (S35–40)PubMed Google Scholar, 25Boncz I. Németh M. Orosz E. et al.FIT performance in early-stage colorectal cancer--letter.Cancer Epidemiol Biomarkers Prev. 2011; 20: 1562Crossref PubMed Scopus (4) Google Scholar]. Another important research topic of the Hungarian OEP is the analysis of hip fractures, including its epidemiology [26Sebestyén A. Tóth F. Sándor J. et al.Correlation between risk factors and subsequent surgical management following internal fixation of intracapsular femoral neck fractures in young adults.Eur J Trauma Emerg Surg. 2011; 37: 503-510Crossref Scopus (7) Google Scholar, 27Péntek M. Horváth C.S. Boncz I. et al.Epidemiology of osteoporosis related fractures in Hungary by the nationwide health insurance database, 1999-2003.Osteoporos Int. 2008; 19: 243-249Crossref PubMed Scopus (58) Google Scholar, 28Sebestyén A. Boncz I. Tóth F. et al.Correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up.Orv Hetil. 2008; 149: 493-503Crossref PubMed Scopus (16) Google Scholar], burden of disease [29Sebestyén A. Boncz I. Nyárády J. Analysis of health insurance costs in cases of patients under 60 years old with medial femoral neck fracture treated primarily with screw fixation or hip replacement.Orv Hetil. 2006; 147: 1129-1135PubMed Google Scholar, 30Sebestyén A. Boncz I. The separate or combined evaluation of co-morbidities have a different effect on the role of surgical delay on 1 year mortality.Ind J Orthop. 2011; 45: 481-482Crossref PubMed Scopus (4) Google Scholar, 31Sebestyen A. Boncz I. Sandor J. Nyarady J. Response to an article in the June 2006 issue of Medical Care.Med Care. 2006; 44: 1148Crossref PubMed Scopus (4) Google Scholar, 32Molics B. Kránicz J. Schmidt B. et al.Utilization of physiotherapy services in case of trauma disorders of the lower extremity in the outpatient care.Orv Hetil. 2013; 154: 985-992Crossref PubMed Scopus (9) Google Scholar], outcomes research [33Sebestyén A. Boncz I. Tóth F. Intra-operative femoral head vascularity assessment: an innovative and simple technique.Ind J Orthop. 2012; 46: 114-115Crossref PubMed Scopus (3) Google Scholar, 34Sebestyen A. Boncz I. Sandor J. Nyarady J. Effect of surgical delay on early mortality in patients with femoral neck fracture.Int Orthop. 2008; 32: 375-379Crossref PubMed Scopus (35) Google Scholar], and evaluation of biological therapies [[35]Laki J. Mónok G. Pálosi M. Gajdácsi J.Z. Economical aspect of biological therapy in inflammatory conditions in Hungary.Expert Opin Biol Ther. 2013; 13: 327-337Crossref PubMed Scopus (10) Google Scholar]. The OEP significantly contributed to the adoption of the directive 89/105/EEC of the Council of the European Communities on transparency in Hungary [[36]Dozsa C. Borcsek B. Boncz I. et al.Experiences of adoption of the directive 89/105/EEC of the council of the European communities on transparency in Hungary.Italian J Pub Health. 2005; 3: 139Google Scholar]. The OEP was also a facilitator for the development of guidelines for conducting economic evaluation of health care interventions in Hungary [[37]Ministry of Health, Social and Family Affairs.Methodological guidelines for conducting economic evaluation of health care interventions in Hungary.J Ministry Health Soc Family Affairs. 2002; 52 (1314)Google Scholar]. Two former board members of the National Health Insurance Fund Administration (OEP) played an important role in the development of health economics in Hungary: Csaba Dózsa, former deputy director general, and Imre Boncz, former department head. Both were the presidents of ISPOR Hungary Chapter. Andor Sebestyén, regional director of OEP, and his colleagues won the best poster presentation award at ISPOR’s Berlin congress in 2012 [[38]Sebestyén A. Gajdácsi J. Patzai B. et al.Seasonal periodicity of secondary hip replacement after femoral neck fractures with reduction internal screw fixation.Value Health. 2012; 15: A403Abstract Full Text Full Text PDF Google Scholar]. Hungarian researchers at universities and research institutes also prefer to conduct a detailed analysis of the nationwide data set of the National Health Insurance Fund Administration. Their research area covers pharmaceutical market analysis [39Kalo Z. Abonyi-Toth Z. Bartfai Z. Voko Z. Pitfalls associated with the therapeutic reference pricing practice of asthma medication.BMC Pulm Med. 2012; 12: 35Crossref PubMed Scopus (4) Google Scholar, 40Kaló Z. Muszbek N. Bodrogi J. Bidló J. Does therapeutic reference pricing always result in cost-containment? The Hungarian evidence.Health Policy. 2007; 80: 402-412Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar], cost-of- illness studies [41Péntek M. Gulácsi L. Rózsa C. et al.Health status and costs of ambulatory patients with multiple sclerosis in Hungary.Ideggyogy Sz. 2012; 65: 316-324PubMed Google Scholar, 42Minier T. Péntek M. Brodszky V. et al.Cost-of-illness of patients with systemic sclerosis in a tertiary care centre.Rheumatology (Oxford). 2010; 49: 1920-1928Crossref PubMed Scopus (43) Google Scholar], and epidemiology [43Csoboth I. Matyus A. Gabara K. Boncz I. Time of taking aspirin can have an effect on the frequency of occurrence of stroke.Chin Med J. 2009; 122: 1119PubMed Google Scholar, 44Kriszbacher I. Koppan M. Bodis J. Inflammation, atherosclerosis, and coronary artery disease.N Engl J Med. 2005; 353: 429-430Crossref PubMed Scopus (144) Google Scholar]. In conclusion, we can emphasize that Hungarian National Health Insurance Fund Administration (OEP) had a significant contribution to the development of health economics and HTA in Hungary through the commitment of its staff members and leaders, by performing the first governmental health-economics evaluations in Hungary, to incorporate cost-effectiveness results into the decision-making process of new medical technologies. I am convinced that ISPOR’s new journal, Value in Health Regional Issues, will serve as a special forum for researchers from the CEEWAA region to increase their activity in scientific publications. Dr. Ferenc Oberfrank was a former secretary of state (1999–2000) at the Ministry of Health and director general (2001–2002) of the National Health Insurance Fund Administration (OEP) in Hungary. Further Steps in the Development of Pharmacoeconomics, Outcomes Research, and Health Technology Assessment in Central and Eastern Europe, Western Asia, and AfricaValue in Health Regional IssuesVol. 2Issue 2PreviewDuring the organizational and functional development of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), more attention was paid to developing regions. In addition to the traditional annual meetings in Western Europe and North-America, the 1st Asia-Pacific Conference and the 1st Latin America Conference were organized in 2003 and 2007, respectively. In addition to Value in Health, its well-established journal, ISPOR introduced Value in Health Regional Issues (ViHRI), its new independent, official scientific journal in 2012. Full-Text PDF Open ArchiveCapacity Building for HTA Implementation in Middle-Income Countries: The Case of HungaryValue in Health Regional IssuesVol. 2Issue 2PreviewMiddle-income countries often have no clear roadmap for implementation of health technology assessment (HTA) in policy decisions. Examples from high-income countries may not be relevant, as lower income countries cannot allocate so much financial and human resources for substantiating policy decisions with evidence. Therefore, HTA implementation roadmaps from other smaller-size, lower-income countries can be more relevant examples for countries with similar cultural environment and economic status. Full-Text PDF Open Archive