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Building Blocks Toward HTA Research in the Philippines

In 2013, the HITAP team began collaboration on HTA with the Philippine Department of Health’s (DOH) National Center for Pharmaceutical Access and Management (NCPAM) that brought recognition and awareness in the Philippines for HTA’s utility in policy decision-making. Supported by the Rockefeller Foundation and NICE International, HITAP and NCPAM conducted two vaccine assessments– the economic evaluation of certain Human Papillomavirus (HPV) and the Pneumococcal Conjugate virus (PCV) vaccines and their potential inclusion to the Philippine healthcare system. HITAP conducted a workshop in March 2013 to prepare the Philippine partners for conducting the HTA for the next six months, from March to September 2013.

These vaccines are especially important in the Philippine context due to the high incidence of cervical cancer and HPV in women and Streptococcuspneumoniae-related diseases (such as pneumonia, meningitis, and other respiratory tract diseases) in children.The studies identified cost effective vaccines as well as strategies to be considered by policy makers – only, however, if they are administered under a comprehensive Universal Health Coverage (UHC) scheme. For the first study, one of the main findings is that HPV vaccine can reduce the burden of cervical cancer by 50%. The primary recommendation was the expansion of VIA (Visual Inspection with Ascetic Acid) targeting 80% of women aged 35-45 years old done at five year intervals and the potentially cost-saving inclusion of the HPV vaccine in the primary care model for 11 year old girls. For the second study, the assessment recommended the implementation of a universal PCV vaccination program (using PCV13, formerly not part of the national formulary drug list) for children. The researches were concluded with a stakeholder consultation with HITAP on the results in March 2014.

The fruitful completion of these HTA prompted a new collaboration: the use of the previous economic evaluation on HPV and PCV vaccines to test the Gates Reference Case (GRC) – a principle-based, standardized methodology for good practice in the planning, conduct and reporting of economic evaluation for informing priority setting in health.The methodology was an output of the Bill and Melinda Gates Foundation’s Methods for Economic Evaluation Project (MEEP) that aims to improve the quality and transparency of economic evaluations.

The researchers will conduct a Disability Adjusted Life Years (DALYs)-based economic evaluation that follows 5 of the 11 recommendations from the GRC. In particular, they defined the DALY specifications, use of economies of scale (previously not included in most studies conducted in this field), the inclusion of human resource impact, the use of a qualitative approach for equity and other ethical concerns, and the use of a model developed by the World Health Organization to address uncertainties in health economic evaluations. HITAP conducted a GRC workshop for their partners on November 4-5, 2014, in preparation for the researches. Collection of data and modifying previous models began in November 2014, with the final reports set to be completed by June 2015.

To effectively conduct these researches, HITAP included capacity development for their Philippine partners as well as international and national activities for HTA development in their collaboration. In addition to the workshops already conducted, short and long-term capacity building activities were implemented and planned. An internship at HITAP for NCPAM staff will soon be realized, as well as formal postgraduate training at the Faculty of Pharmacy, Mahidol University, Thailand, for two NCPAM staff. The two teams plan to select HTA topics in the Philippines and involve various stakeholders in the process. To help ensure the quality of HTA, the Philippines Methods Manual on Drug Evaluation (Guidelines) will be completed in 2015. For international collaboration and government support, NCPAM will participate in the HTAsiaLink 2015 conference in Taipei and Philippine policymakers will join in the PMAC meeting in 2016. Finally, a memorandum of understanding (MoU) concerning future collaborations on HTA and establishing HTA as a tool for research in the Philippines will be signed between the DOH of the Philippines and the Ministry of Public Health of Thailand during the Prince Mahidol Award Conference (PMAC) 2015 meeting, on January 28, 2015. With these sustainable and forward-looking efforts, HITAP and NCPAM work together with an end-goal of establishing a functioning and successful HTA agency in the Philippines.