A scoping visit to the Philippines took place in December 2012 to explore possible areas of support. The visit identified a number of specific activities relating to vaccine evaluation techniques, Z-package optimisation and the processes and methods used by the Formulary Executive Committee (FEC) when making drug inclusion/exclusion decisions.
EQ-5D workshop in Manila
Francis Ruiz chaired a workshop on the EQ-5D tool in Manila as part of an ongoing Rockefeller funded project led by NICE International and HITAP in the Philippines. The workshop itself was led by two EuroQol experts on the instrument Professor Jan Busschbach, Director of the section Medical Psychology and Psychotherapy, Erasmus University and Chair of the Board of the EuroQol Research Foundation; and Dr. Nan Lou, Senior researcher at the National University of Singapore, Saw Swee Hock School of Public Health, member of the Value Sets Working Group of the EuroQol Group and Chair of the Singapore Chapter of ISPOR.
Attendees at the workshop included key Philippine stakeholders in academia, PhilHealth and the Department of Health, as well as representation from the Philippine Chapter of ISPOR. At the workshop, participants learnt about the development of the three-level and five-level versions of the tool, and ongoing studies in the Philippines that have made use of the EQ-5D. The workshop concluded with outlining a proposal for initiating a study to obtain five-level value sets relevant for the Philippine context. This work will be important in the ongoing progress made in the country, supported by the NICE international and HITAP engagement, in supporting the effective use of HTA in decision making.
Filipino expert committee for clinical practice guidelines
Francis Ruiz of NICE International, and Dr John Graham, Consultant in oncology and Director of the National Collaborating Center for Cancer which produces guidelines for NICE, attended a meeting of the Expert Committee (Chaired by Dr Jorge Ignacio) responsible for developing Philippine relevant clinical practice guidelines for early breast cancer, working with Filipino academics. Following presentations by the NICE International team that described cancer guideline developement processes and methods in England and Wales, and the role of cost-effectiveness considerations, there was a discussion among all partcipants regarding how best to develop useful guidelines in contexts where there are limited technical and other resources available for that purpose. There was a discussion on the opportunities available to adapt/adopt guidelines developed in other jurisdictions, and pragmatic approaches to take into account the budget impact of recommendations. The Philippine guidelines when developed, will have an important role in informing the content and reimbursement rate of the z-package for early breast cancer, provided by PhilHealth. The z-package programme of PhilHealth aims to provide coverage against significant, ‘catastrophic expenditure’ and also collect data on the type of care provided and the health outcomes achieved. This is part of a broader ambition to support universal healthcare coverage
As part of on-going technical support in health technology assessment (HTA) and evidence-based policy making in the Philippines an introductory workshop on the application of HTA in priority setting was delivered in Manila on the 29-30 October, 2013. This complements previous training activities led by colleagues from HITAP of Thailand, with their focus on vaccine evaluation and the development of Philippine-relevant cost-effectiveness analyses.
The course was led by Professor Mike Clarke of the All-Ireland Hub for Trials Methodology Research and Francis Ruiz, Senior Adviser at NICE International. Participants included members of the Formulary Executive Committee; academic partners who are or will be involved in developing local assessments to support decision making; representatives of the social insurer, Philhealth, and the Philippine Food and Drug Administration; and members of the National Center for Pharmaceutical Access and Management (NCPAM) secretariat.
Topics covered in the workshop included systematic review and critical appraisal, the use of HTA in selected countries including the UK and Thailand, economic evaluation, setting standards, and the role of financial and non-financial incentives in driving the uptake of good quality, cost-effective, practice.
Attendees considered the workshop to be a valuable introduction to HTA and priority setting, which highlighted the need for effective institutional arrangements in the Philippines to support further development of evidence-based policy making. Participants also expressed enthusiasm to further deepen their understanding of key methodological issues, particularly the application of standardised tools to assess health-related quality of life. A separate workshop on the use of EuroQol’s EQ-5D instrument in decision making is being organised for 2014.
Training workshop in Tagaytay, Philippines
NICE International participated in a three-day training workshop in Tagaytay, Philippines. The workshop was led by Thai partners on this project, the Health Intervention and Technology Assessment Program (HITAP). HITAP are providing expert support on vaccine evaluation to representatives of the Philippine Department of Health and PhilHealth, the national health insurance program of the Philippines, among others. This work includes training and hands-on technical support in the development of localised economic models for human papillomavirus (HPV) vaccine and pneumococcal conjugated vaccine (PCV). The two vaccines were selected because they are key issues for policy makers in the Philippines, and HITAP has extensive expertise and experience in the asessment of these particular technologies.
Meeting with key figures involved in the Z-(benefit) package in the Philippines
Francoise Cluzeau and Tommy Wilkinson met with Filipino colleagues to scope the work for refining a standardised treatment package of care for breast cancer patients. They met with representatives from the Philippine Department of Health, PhilHealth, National Center for Disease Prevention and Control, Philippine Cancer Society, National Institute for Health and oncologists and surgeons. Together they outlined activities NICE International can undertake to help build local capacity for developing/adapting clinical Guideline and Pathways as well as processes to help PhilHealth refine and implement its breast cancer Z-package.
Visit to the Philippines with colleagues from HiTAP
Following the scoping visit NICE International (Francis Ruiz) and two representatives from HITAP (Dr Sripen Tantivess and Ms Waranya Rattanavipapong) visited Manila in March 2013. During the visit, feedback was provided on the methods and processes used by the FEC. Meetings and discussions took place with representatives from PhilHealth regarding the ongoing work on the Z-packages. The team also met with the Philippine Department of Health’s National Center for Disease Prevention and Control, and the WHO regional office (Western Pacific).