Assessing the feasibility of conducting and using health technology assessment in Colombia: The case of severe haemophilia A

Health Technology Assessment (HTA) examines the consequences of the application of health technologies. HTA is aimed at better informing decision-makers. In November 2012 Colombia established its own HTA agency (IETS). Up until the establishment of IETS, HTA had had a limited role in providing information to set priorities. Severe haemophilia A (SHA), an infrequent disorder of blood coagulation, serves as a good example of how the adoption of new technologies can change the course of a disease while challenging the financial sustainability of health systems. The aim of this study was to assess the feasibility of conducting and using HTA to inform decisionmaking in Colombia. To fulfil these aims a mixed methods approach was used. Because decisionmaking is a task embedded in a complex and highly customised context, the case study method was considered as appropriate. Through a qualitative approach using semi- structured interviews ten “drivers” emerged with the ability to help or hinder HTA: availability and quality of data, implementation strategy, cultural aspects, local capacity, financial support, policy/political support, globalisation, stakeholder pressure, health system context and usefulness perception. A CUA from the Colombian health system perspective was developed to assess the cost-effectiveness of primary prophylaxis (PP) versus on-demand (OD) provision of FVIII for SHA. The ICER of PP with FVIII compared to OD was COL$105,081,022 (USD$55,204) per QALY gained. This is not considered costeffective using a hypothetical threshold of up to three times the GDP per-capita.Two approaches were used to assist decision-making for PP in Colombia, including EVIDEM. The final reimbursement decision about PP in Colombia would be “it would not be prioritised”. Nonetheless, the final valuation of technologies was sensitive to the methods and criteria used to assist decisionmaking. The combined results of the research appear to suggest that HTA development and use in Colombia is feasible, even for technologies that are difficult to evaluate. Results of this research work could be of significant value to the field of public health and policy since resource-allocation decisions in many settings similar to Colombia have often been made without enough evidence-based information. Further research in the field of priority-setting is still required.