Is It Time for Joint Health Technology Assessment in Asia? Opportunities and Challenges.

This volume, Value in Health Regional Issues (ViHRI) Volume 12, is the first Asia issue since our journal was awarded with a higher international journal standard by being indexed in MEDLINE/ PubMed. The achievement may not have been possible without the great contributions made by the authors of all of the previously published articles. This particular issue covers studies from the Asia-Pacific region, under the categories of patientreported outcome, economic evaluation, preference-based assessment, systematic review, health policy analysis, policy perspective, and comparative effectiveness research. Diverse researchers from many countries have been engaged in producing this volume. The countries/regions include Singapore, China, Thailand, Taiwan, Australia, Iran, Indonesia, India, Japan, Philippines, and South Korea, where outcomes research and health technology assessment (HTA) has been used for decision making in one way or another. The current issue, ViHRI Volume 12 Asia 2017, received 47 manuscript submissions in total. Of these, 18 have been accepted. The majority of studies in the 2017 Asia volume remain typical of health economics and outcomes research, including cost-effectiveness, budget impact, cost-benefit, burden of disease, and cost studies. Of this volume’s accepted manuscripts, 34% (6 out of 18) fall into these typical groupings, which is, however, somewhat lower than its proportion of 47% in the 2016 volume. Another major category of study reports accepted for publication comprises articles on patient-reported outcomes, accounting for 28% (5 of 18) of the total. The rest of the accepted articles (7 of 18) are evenly distributed among other categories, including health policy, systematic review, preference-based assessment, comparative effectiveness research, policy perspective, brief report, and commentary. The commentary article from China could be considered an article in the category of policy perspective. It is to be noted that an increasing number of policy-related manuscripts were submitted during the past year. We are pleased to carry a few of them as quality-proven and meaningful articles in this volume. Overall, the submissions indicated that ViHRI has attracted high-quality manuscripts on health economics and outcomes research in the Asia-Pacific region. Upon publishing this volume, we would like to touch on an emerging issue, joint HTA, which could be interesting to most policymakers in this region of continuous development of HTA systems. HTA is essential for the priority setting process in health care resource allocation [1]. Many countries in Asia have formally adopted HTA in their decision-making processes, especially when they are faced with costly technology, and some countries are considering taking or working toward the same direction. These countries need HTA because their total health care spending has increased drastically as a result of aging populations, increasing health risks (e.g., communicable and noncommunicable diseases), and use of innovative technologies. These needs have outgrown these countries’ efforts for overcoming two classic challenges—the limited number of scientists and limited resources for HTA in Asia. Primarily, each country tries to build its own HTA capacity. Some countries have experienced greater success compared with others. However, it is widely known that pharmaceutical companies have segregated their markets into regional areas and have used similar or relational pricing and marketing strategies in these markets. There is, therefore, a critical need for the countries in Asia to ask an important question: Is it time for joint HTA in Asia? We have posed this provocative question to the readers of ViHRI here, and we intend to discuss the opportunities and challenges for those who agree or disagree with the idea of joint HTA. It is our hope that we can persuade or generate further discussions among all stakeholders, including researchers and policymakers in Asia. The joint HTA idea is not new, since it has been implemented in Europe as the European Network for Health Technology Assessment (EUnetHTA) for several years. It started with development of guidelines and tools. Recently, the effort has been advanced to include joint assessment. The joint HTA in Asia may not be the same as that in Europe, but the Asian countries can potentially develop a unique joint HTA platform based on their social, political, and economic backgrounds. In addition, joint HTA in Asia can benefit from the model of the EUnetHTA and move faster. For those who agree with the joint HTA idea in Asia, there are two major opportunities for the creation of joint HTA. First, there are existing networks or links for HTA across countries. Intuitively, the countries, including those inside and outside of Asia, with greater success in using HTA to contain health care costs are role models for the countries in Asia. The successful countries have provided assistance and shared resources through certain HTA networks or links, for example, International Network of Agencies for Health Technology Assessment (INAHTA) and International Decision Support Initiative (iDSI). Among the countries in Asia, there are also existing HTA networks or links, for example, Asia-Pacific Regional Capacity Building for HTA (ARCH) and HTAsiaLink. Therefore, if the countries in Asia ever agree upon the idea of joint HTA, the existing networks or links