Research Health Technology Assessment Research Articles

PIH39 - Patient-Reported Outcomes within Health Technology Assessment Decision Making: Current Status and Implications for Future Policy

In contrast to regulatory settings, research on using patient-reported outcome (PRO) data within health technology assessment (HTA) is limited. The objectives of this research were to: 1) document PRO guidance within HTA; 2) explore manufacturers’ compliance with this; 3) understand the HTA body’s acceptance of deviations from the guidance; and 4) identify areas of improvement within this process to close the gap between HTA and PRO research. After identifying PRO-related guidance from the National Institute for Health and Care Excellence (NICE), documentation on new single technology appraisals (STAs) published throughout 2014 was reviewed to identify PRO data usage and its compliance with NICE’s guidance. Reviews of existing STAs, and medical device STAs were excluded. PRO data supporting cost-effectiveness and clinical-effectiveness was explored. NICE published new guidance on 19 pharmaceutical products throughout 2014; 16 documented a recommendation. Regarding cost-effectiveness, PRO approaches mostly adhered to NICE guidance, with 87% of recommended STAs measuring health-related quality of life (HRQoL) using the EQ-5D. However, transparency regarding the valuation of HRQoL appears to be lacking; 52% of submissions did not provide the valuation method. Over half (62%) of recommended guidance documents cited PRO data to support clinical-effectiveness. Despite NICE guidance on outcome measures used to support clinical-effectiveness (requesting evidence of reliability or validity) this was only mentioned by the manufacturer for 25% of the measures used. Interestingly, neither the evidence review group nor committee made any comment regarding this disconnect. Although PRO data’s role in supporting cost-effectiveness is clearly guided and adhered to, transparency issues remain. In contrast, clinical-effectiveness guidance is vague and compliance is very low which appears to be currently unrecognised as an issue. Therefore, a more stringent approach is needed when assessing PRO data within HTA, to ensure accurate measurement of treatment effectiveness to inform better decision making.

Effectiveness and cost-effectiveness of interferon beta and glatiramer acetate in the UK Multiple Sclerosis Risk Sharing Scheme at 6 years: a clinical cohort study with natural history comparator

In 2002, the UK's National Institute for Clinical Excellence (NICE) concluded that interferon beta and glatiramer acetate would be cost effective as disease-modifying therapies (DMTs) for multiple sclerosis only if the short-term disability benefits reported in clinical trials were maintained. The UK Multiple Sclerosis Risk Sharing Scheme (RSS) was established to assess whether disability progression was consistent with a cost-effectiveness target of £36 000 per quality-adjusted life-year projected over 20 years. We aimed to evaluate the long-term effectiveness and cost-effectiveness of these DMTs by comparing a cohort of patients with relapsing-remitting multiple sclerosis enrolled in the UK RSS with a natural history cohort from British Columbia, Canada. In our clinical cohort we included patients starting a DMT who were enrolled in the UK RSS who had relapsing multiple sclerosis at baseline and had at least one further clinical assessment. In our control cohort we included patients in the British Columbia multiple sclerosis database (BCMS; data collection 1980-96) who met the same eligibility criteria as for the RSS cohort. We compared disability progression at 6 years for RSS patients with untreated progression modelled from BCMS patients using continuous Markov and multilevel models. The primary outcomes were the progression ratio (treated vs untreated) measured both in Expanded Disability Status Scale (EDSS) score and utility. A ratio of less than 100% for EDSS implied slower than expected progression on treatment compared with off treatment; a utility ratio of 62% or less implied that the DMTs were cost effective. 5610 patients starting a DMT were enrolled in the UK RSS between Jan 14, 2002, and July 13, 2005 (72 sites), of whom 4137 were included in our clinical cohort. We included 898 BCMS patients in the control cohort who met the RSS inclusion criteria and had at least one EDSS score after baseline. RSS patients had a mean follow-up of 5·1 years (SD 1·4). Both models showed slower EDSS progression than predicted for untreated controls (Markov model, 75·8% [95% CI 71·4-80·2]; multilevel model, 60·0% [56·6-63·4]). Utility ratios were consistent with cost-effectiveness (Markov model, 58·5% [95% CI 54·2-62·8]; multilevel model, 57·1% [53·0-61·2]). Findings from this large observational study of treatment with interferon beta or glatiramer acetate provide evidence that their effects on disability in patients with relapsing-remitting multiple sclerosis are maintained and cost effective over 6 years. Similar modelling approaches could be applied to other chronic diseases for which long-term controlled trials are not feasible. Health Departments of England, Wales, Scotland, and Northern Ireland, Biogen Idec, Merck Serono, Bayer Schering Pharmaceuticals, Teva Pharmaceuticals Industries, UK National Institute of Health Research's Health Technology Assessment Programme.

Differences in evaluating health technology assessment knowledge translation by researchers and policy makers in China.

The aim of this study was to examine the gaps between researchers and policy makers in perceptions and influencing factors of knowledge translation (KT) of health technology assessment (HTA) in China. A sample of 382 HTA researchers and 112 policy makers in China were surveyed using structured questionnaires. The questionnaires contained two sections: perceptions of HTA research and assessments of six-stage KT activities. Wilcoxon rank sum test was applied to compare the differences in these two sections between HTA researchers and policy makers. Multivariate linear regression was performed to explore KT determinants of HTA for researchers and policy makers separately. Policy makers and researchers differed in their perceptions of HTA research in all items except collaboration in research development and presentation of evidence in easy-to-understand language. Significant differences in KT activities existed in all the six stages except academic translation. Regarding KT determinants, close contact between research unit and policy-making department, relevance of HTA to policy making, and importance of HTA on policy making were considered facilitators by both groups. For researchers, practicality of HTA report and presentation of evidence in easy-to-understand language can facilitate KT. Policy makers, on the other hand, considered an overly pedantic nature of HTA research as an obstacle to effective KT. Substantial gaps existed between HTA researchers and policy makers regarding the perceptions of HTA research and KT activities. There are also some differences in KT determinants by these two groups. Enhancing collaboration, promoting practicality and policy relevance of HTA research, and making HTA findings easily understood are likely to further the KT of HTA evidence.

Ten Years Of Development Studies In Health Technology Assessment In Brazil: Profile Of Studies And Operational Indicators.

of sixteen countries from the region according to different criteria: characteristics, quality (using Drummond’s checklist), use of local data, addressed inputs limitation and results transferability. Results: Economic evaluations are used in CEE countries for informing decision making, while critically considering methodology, quality and study’s reliability. Experts acknowledged limited generalizability of study results both between and within geographic regions. Meanwhile, despite these constraints, facing limited health technology assessment (HTA) capacity experts were still using foreign evidence. At the same time, the usefulness of studies published in CEE and former Soviet countries to inform their decision making is limited because of insufficient transparency in reporting, unaddressed uncertainty, limited insight on inputs and transferability of results. Although local costs, baseline risk and resource use data are required, experts accept evidence originating from health care settings outside CEE and former Soviet countries regarding relative effect and utilities values. ConClusions: HTA priority setting and transferability assessment of economic evidence are important issue in health care decision making in CEE and former Soviet countries, since HTA research capacity is limited and local evidence is scarce. For this purpose, quality, transparency, and transferability should be addressed explicitly in published economic evaluations originating from CEE and former Soviet countries.

Post-marketing access to orphan drugs: a critical analysis of health technology assessment and reimbursement decision-making considerations

This study aims to explore the current rationale of post-marketing access to orphan drugs. As access to orphan medicinal products depends on assessment and appraisal by health authorities, this article is focused on health technology assessment (HTA) and reimbursement decision-making considerations for orphan drugs. A critical analysis may identify important factors that could predetermine the combined outcomes of these two processes. Following this objective, an analytical framework was developed, comprising three overlaying issues: to outline what is currently done and what needs to be done in the field of HTA of orphan drugs, to synthesize important variables relevant to the reimbursement decision-making about orphan drugs, and to unveil relationships between theory and practice. Methods for economic evaluation, cost-effectiveness threshold, budget impact, uncertainty of evidence, criteria in reimbursement decision-making, and HTA research agenda are all explored and discussed from an orphan drug perspective. Reimbursement decision-making for orphan drugs is a debate of policy priorities, health system specifics, and societal attitudes. Health authorities need to pursue a multidisci - plinary analysis on a range of criteria, ensuring an explicit understanding of the trade-offs for decisions related to eligibility for reimbursement. The only reasonable way to accept a higher valuation of orphan drug benefits is if these are demonstrated empirically. Rarity means that the quality of orphan drug evidence is not the same as for conventional therapies. Closing this gap is another crucial point for the timely access to these products. The generation of evidence goes far beyond pre-market authorization trials and requires transnational cooperation and coordination. Early constructive dialogue among orphan drug stakeholders and elaboration of orphan drug-tailored methodology tools could set the scene for ongoing accumulation of evidence, as well as for proper and timely assessment and appraisal.

The National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme

The National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme

Methods Development for Health Technology Assessment

Most health care systems internationally have to face the problem of how to allocate limited resources across interventions and programs. This is true for any collectively funded system, whether financed from general taxation, private or social insurance, or a mix of sources. In part this relates to decisions about which medical technologies to fund and, in particular, whether to devote the system’s resources to the numerous new pharmaceuticals, devices, and procedures that become available each year. Health technology assessment (HTA) offers a broad set of tools to support these types of decisions including systematic review, analysis of clinical studies and routine administrative data, health outcome measurement and valuation, and economic evaluation. Jurisdictions differ in the way they use these tools. Some systems, such as those in Germany and the public sector systems in the US, use largely clinical evidence from trials, perhaps augmented with information on the impact of technology adoption on the system’s budget. In contrast, an increasing number of systems, including those in the UK, Canada, and Australia, inform decisions by synthesizing clinical evidence more formally with data on costs and patients’ health outcomes using cost-effectiveness analysis. Despite this variety of ways in which HTA is used to support decision making, there are common issues that the HTA research community has sought to inform. The most appropriate ways in which HTA is used to inform decisions is one such issue. For example, in this issue of Medical Decision Making, Stevens and Longson describe the process by which the National Institute for Health and Clinical Excellence (NICE) uses HTA to support decision making on new pharmaceuticals and other technologies in England and Wales and the challenges faced in using HTA for this purpose. Taking an international perspective, Neumann and others have reported on the extent to which 14 organizations using HTA to support decisions adhere to a series of key principles suggested by the International Working Group for HTA Advancement and organized into 4 broad areas: the structure of the program, methods, processes, and use of HTA in decision making. The review demonstrated considerable variation across organizations in the extent to which these principles were evident in the process and methods used. Another important issue relating to the use of HTA to support decisions across a range of health systems is methodological uncertainty: Is the range of available HTA methods appropriate and fit for the purpose of informing decisions? Because many health systems have sought to use evidence and analysis to support resource allocation, questions have arisen about the adequacy of existing practices and the need for methodologists to sharpen the tools in the HTA toolbox. A key challenge, however, is to characterize the major gaps in existing methods and to set priorities for methods research. To a large extent the scientific community has determined these priorities through the work it undertakes. Indeed, there has been a flow of methods research for HTA, much of it published in this journal. For example, this issue sees contributions on the methods of systematic review with the purpose of speeding up the process of identifying new studies; various methods to estimate parameters relevant to HTA decisions, including the derivation of preference-based measures of health from disease-specific, patient-reported outcome From the University of York, York, UK (MS).

ASSESSING THE IMPACT OF HEALTH TECHNOLOGY ASSESSMENT ON THE AUSTRIAN HEALTHCARE SYSTEM

In Austria, research in health technology assessment (HTA) has been conducted since the 1990s. The aim of this study is to analyze whether the HTA research program of the Institute of Technology Assessment (ITA) and the Ludwig Boltzmann Institute for HTA (LBI-HTA) have had an impact on the Austrian healthcare system. We applied qualitative and quantitative empirical research methods, such as interviewing, download analysis, questionnaire, retrospective routine data analysis, and media analysis. Data were analyzed according to a conceptual framework, considering seven impact categories (awareness, acceptance, process, decision, practice, final outcomes, enlightenment) and different target groups. A rising number of downloads and single HTA reports with high media interest were identified. Interviews showed that HTA reports have increasingly been used for investment and reimbursement decisions, as well as for the preparation of negotiations. Economic impact was indicated by decreased expenditures due to HTA recommendations. Overall, knowledge about evidence-based medicine increased and, in places, an "HTA culture" can be recognized. Yet, several decision-making processes occur at all levels without the use of HTA. The analysis demonstrated an impact within all predefined categories; however, it depends on the system level and its target groups. HTA reports are primarily used by hospital management, (social) insurances, and the Austrian Ministry of Health. Nevertheless, there is still potential to increase the impact of HTA. Therefore, the inclusion of HTA in decision-making processes in Austria needs to move from a voluntary basis to a mandatory one.

The National Institute for Health Research (Nihr) Health Technology Assessment (Hta) Programme

The National Institute for Health Research (Nihr) Health Technology Assessment (Hta) Programme

International survey of methods used in health technology assessment (HTA): does practice meet the principles proposed for good research?

International survey of methods used in health technology assessment (HTA): does practice meet the principles proposed for good research? Jennifer M Stephens,1 Bonnie Handke,2 Jalpa A Doshi3 On behalf of the HTA Principles Working Group, part of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) HTA Special Interest Group (SIG)1Pharmerit International, Bethesda, MD, USA; 2Medtronic Neuromodulation, Minneapolis, MN, USA; 3Center for Evidence-Based Practice and Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USAObjective: To describe research methods used internationally in health technology assessment (HTA) and health-care reimbursement policies; compare the survey findings on research methods and processes to published HTA principles; and discuss important issues/trends reported by HTA bodies related to current research methods and applications of the HTA process.Methods: Representatives from HTA bodies worldwide were recruited to complete an online survey consisting of 47 items within four topics: (1) organizational information and process, (2) primary HTA methodologies and importance of attributes, (3) HTA application and dissemination, and (4) quality of HTA, including key issues. Results were presented as a comparison of current HTA practices and research methods to published HTA principles.Results: The survey was completed by 30 respondents representing 16 countries in five major regions, Australia (n = 3), Canada (n = 2), Europe (n = 17), Latin America (n = 2), and the United States (n = 6). The most common methodologies used were systematic review, meta-analysis, and economic modeling. The most common attributes evaluated were effectiveness (more commonly than efficacy), cost-effectiveness, safety, and quality of life. The attributes assessed, relative importance of the attributes, and conformance with HTA principles varied by region/country. Key issues and trends facing HTA bodies included standardizing methods for economic evaluations and grading of evidence, lack of evidence, and data availability for emerging technologies.Conclusion: This is the first international survey to specifically assess the state of HTA research methods. Future efforts should expand the respondent sample to include more emerging markets and update the results of this survey to specifically address additional aspects of research methods in HTA.Keywords: survey, technology assessment, payers, research methods, reimbursement

Continuing Professional Development: Diagnosis and management of minor head injury in the UK

Overview Head injury accounts for a large amount of emergency services work in the UK. This article summarizes the findings of studies undertaken for the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme examining the available evidence regarding the diagnostic management of minor head injuries. These studies included a review of current practice in the management of minor head injured patients (GCS 13–15) by way of a survey of UK emergency departments. We also performed a systematic review of the head injury literature to identify the most accurate clinical decision rule for adults (Canadian CT Head Rule) and children (Paediatric Emergency Care and Research Network) and commented on the applicability of these in the UK population. This review helped to identify the most significant clinical findings that increase the likelihood of intracranial and neurosurgical injury, following minor head injury in adults, children and infants. Finally, we have highlighted where these findings may be relevant to UK paramedic practice, in particular in influencing the decision to transfer patients to the emergency department. Learning Outcomes After completing this module you will: • Have an understanding of the significant clinical characteristics following head injury • Understand potential pathological problems following head injury • Be able to assess the relevant clinical features of all patients following head injury • Be familiar with key clinical decision rules for patients with head injury • Be able to provide the appropriate pre-hospital management for all head injured patients.

An uneven spread: A review of public involvement in the National Institute of Health Research's Health Technology Assessment program

This study comprises a review of public involvement strategies across the five stages of research management in the UK's HTA program at the end of a 10-year period. These five stages are: identification of topics; prioritization of these topics as researchable questions; commissioning of research; monitoring of projects throughout their implementation; and publication and dissemination of findings. Internal HTA documentation was analyzed alongside narrative analysis of semi-structured interviews of program staff, and a rapid review of published literature. Public involvement strategies have developed with the growth of the HTA program but were spread unevenly across the five stages of research management. Public involvement was present in identification, strongest in prioritization, present in commissioning but minimal in monitoring and absent in publication and dissemination. The HTA program has developed public involvement strategies but mainly in prioritization. Further research is required to ascertain where public involvement can be most appropriately used and to evaluate its impact.

Errors noted in: Re: Migliore A, Bizzi E, Broccoli S Laganà (2011). Indirect comparison of etanercept, infliximab, and adalumimab for psoriatic arthritis: mixed treatment comparison using placebo as common comparator. Published on line June 21st 2011

Search strategy/included studies The authors included a total of four clinical trials [1–4]. A similar, but more comprehensive, analysis produced as part of the National Institute for Health Research (NIHR) Health Technology Assessment programme [5] included two additional trials [6, 7] that would appear to meet the Migliore et al. search criteria. Data analysis If the data included in the analysis conforms to the studies as described in Table 2, none of the conclusions are valid. As far as can be ascertained, the trial described under the heading for Mease et al. (Reference 11)—adalumimab—is an infliximab trial [2]. The trial described under the heading Antoni et al. (Reference 9)—infliximab—is an adalumimab trial [4]. This is not a transposition error; the infliximab trial referenced [2] is to a study that included a total of 104 patients; none of the trial descriptions matches this.

Diagnosis and management of minor head injury in the UK

Head injury accounts for a large amount of emergency services work in the UK. We performed a review of current practice in the management of minor head injured patients (GCS 13-15) by way of a survey of UK emergency departments. Nearly all departments (∼95%) reported unrestricted access to computer tomography (CT) scans. Admission rates for minor head injured patients were 18% for adults and 9% for children. From our systematic review, we identified the most accurate clinical decision rule for adults (Canadian CT Head Rule) and children (Pediatric Emergency Care and Research Network) and commented on the applicability of these in the UK population. We also identified the most significant clinical findings that increase the likelihood of intracranial and neurosurgical injury, following minor head injury in adults, children and infants. Finally, we have highlighted where these findings may be relevant to UK paramedic practice, in particular in influencing the decision to transfer patients to the emergency department. This article summarizes the findings of studies undertaken for the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme examining the available evidence regarding the diagnostic management of minor head injuries. It will be published in a number of articles and a full report for the HTA programme.

Health technology assessment (HTA) increasingly important in spine research

Health technology assessment (HTA) increasingly important in spine research

Wie kann der Impact von Health Technology Assessment (HTA) im österreichischen Gesundheitssystem ermittelt werden? Die Entwicklung eines Analyseinstruments

In Austria research in Health Technology Assessment (HTA) has been conducted since the 1990s. Research in HTA aims at supporting an adequate and efficient use of health care resources in order to sustain a publicly financed and solidary health care system. Ultimately, HTA research should result in better health of the population. Research results should provide independent information for decision makers. For legitimizing further research resources and for prioritizing future HTA research and guaranteeing the value of future research, HTA research needs itself to undergo evaluation. Aim of the study is to design a conceptual framework for evaluating the impact of HTA research in Austria on the basis of the existing literature. An already existing review which presents methods and concepts how to evaluate HTA-impact was updated by a systematic research including literature of the years 2004-January 2010. Results were analysed in regard to 4 categories: definition of the term impact, target groups and system levels, operationalisation of indicators and evaluation methods. Overall, 19 publications were included. Referring to the 4 categories, an explanation of impact has to take into account HTAs multidisciplinary setting and needs a context related definition. Target groups, system levels, indicators and methods depend on the impact defined. Studies investigated direct and indirect impact and were focused on different target groups like physicians, nurses and decision makers on the micro-, and meso level, as well as politicians and reimbursement institutions on the macro level. Except for one reference all studies applied already known and mostly qualitative methods for measuring the impact of HTA research. Thus, an appropriate pool of instruments seems to be available. There is a lack of information about validity of applied methods and indicators. By adapting adequate methods and concepts a conceptual framework for the Austrian HTA-Impact evaluation has been designed. The paper presents an overview of existing methods for the evaluation of the HTA research. This has been used to identify useful approaches for measuring the HTA-impact in Austria. By providing a context sensitive framework for impact evaluation in Austria the Austrian HTA-research contributes to the international trend of impact-evaluation.

Priority setting for health technology assessment at CADTH

The aim of this study was to describe a current practical approach of priority setting of health technology assessment (HTA) research that involves multi-criteria decision analysis and a deliberative process. Criteria related to HTA prioritization were identified and grouped through a systematic review and consultation with a selection committee. Criteria were scored through a pair-wise comparison approach. Criteria were pruned based on the average weights obtained from consistent (consistency index < 0.2) responders and consensus. HTA proposals are ranked based on available information and a weighted criteria score. The rank, along with additional contextual information and discussion among committee members, is used to achieve consensus on HTA research priorities. Six of eleven criteria represented > 75 percent of the weight behind committee member decisions to conduct an HTA. These criteria were disease burden, clinical impact, alternatives, budget impact, economic impact, and available evidence. Since May 2006, committees have considered 102 proposals at sixteen biannual in-person advisory committee meetings. These have selected twenty-nine research priorities for the HTA program. The approach works well and was easy to implement. Feedback from committee members has been positive. This approach may assist HTA and other research agencies in better priority setting by informing the selection of the most important and policy-relevant topics in the presence of a wide variety of research proposals. This may in turn lead to efficiently allocating resources available for HTA research.

Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial

MRI might improve diagnosis of breast cancer, reducing rates of reoperation. We assessed the clinical efficacy of contrast-enhanced MRI in women with primary breast cancer. We undertook an open, parallel group trial in 45 UK centres, with 1623 women aged 18 years or older with biopsy-proven primary breast cancer who were scheduled for wide local excision after triple assessment. Patients were randomly assigned to receive either MRI (n=816) or no further imaging (807), with use of a minimisation algorithm incorporating a random element. The primary endpoint was the proportion of patients undergoing a repeat operation or further mastectomy within 6 months of random assignment, or a pathologically avoidable mastectomy at initial operation. Analysis was by intention to treat. This study is registered, ISRCTN number 57474502. 816 patients were randomly assigned to MRI and 807 to no MRI. Addition of MRI to conventional triple assessment was not significantly associated with reduced a reoperation rate, with 153 (19%) needing reoperation in the MRI group versus 156 (19%) in the no MRI group, (odds ratio 0.96, 95% CI 0.75-1.24; p=0.77). Our findings are of benefit to the NHS because they show that MRI might be unnecessary in this population of patients to reduce repeat operation rates, and could assist in improved use of NHS services. National Institute for Health Research's Health Technology Assessment Programme.

The National Institute for Health Research (Nihr) Health Technology Assessment (Hta) Programme

The National Institute for Health Research (Nihr) Health Technology Assessment (Hta) Programme

Historical development of health technology assessment in Thailand

This study aims to review the development of health technology assessment (HTA), including the socioeconomic context, outputs, and policy utilization in the Thai setting. This study was conducted through extensive document reviews including these published in both domestic and international literature. Evidence suggests that contextual elements of the health system, especially the country's economic status and health financing reforms, as well as their effects on government budgeting for medical and public health services, played an important role in the increasing needs and demands for HTA information among policy makers. In the midst of substantial economic growth during the years 1982 to 1996, several studies reported the rapid diffusion and poor distribution of health technologies, and inequitable access to high-cost technology in public and private hospitals. At the same time, economic analysis and its underpinning concept of efficiency were suggested by groups of scholars and health officials to guide national policy on the investment in health technology equipment. Related research and training programs were subsequently launched. However, none of these HTA units could be institutionalized into national bodies. From 1997 to 2005, an economic recession, followed by the introduction of a universal health coverage plan, triggered the demands for effective measures for cost containment and prioritization of health interventions. This made policy makers and researchers at the Ministry of Public Health (MOPH) pay increasing attention to economic appraisals, and several HTA programs were established in the Ministry. Despite the rising number of Thai health economic publications, a major problem at that period involved the poor quality of studies. Since 2006, economic recovery and demands from different interests to include expensive technologies in the public health benefit package have been crucial factors promoting the role of HTA in national policy decisions. Meanwhile, HTA capacity has been strengthened through the establishment of many health economic and HTA initiatives. An illustration of the work and contributions of the Health Intervention and Technology Assessment Program (HITAP) is provided. In this phase, HTA policy integration has been enhanced through different mechanisms and organizations. Over the past two decades a notable progression has been made in relation to the capacity building of HTA research and its policy utility in Thailand. Such development has been shaped by multiple factors. It is anticipated that experience gained among academics, health officials, and civil society organizations will be helpful not only in sustaining the momentum but also in improving formal HTA systems in the future.