Swiss Multi-Stakeholder HTA Consensus Project
In the past, Health Technology Assessment (HTA) initiatives in Switzerland had been fragmented and impaired by blurred boundaries between assessments and appraisals as well as limited by a number of methodological issues.
Therefore, "SwissHTA" – as a transparent and inclusive process – was initiated by santésuisse (the national association of sick funds) and Interpharma (federal association of the Swiss research-based pharmaceutical industry) to develop a multi-stakeholder consensus on the future implementation of official HTAs in Switzerland. The process was led by a project steering committee, with membership from santésuisse, Interpharma, the Swiss federal government (Bundesamt für Gesundheit, BAG, as an observer), the Swiss Medical Association (FMH), the Swiss Academy of Medical Sciences (SAMW), the Swiss Conference of Cantonal Health Directors (Schweizerische Konferenz der kantonalen Gesundheitsdirektorinnen und -direktoren, GDK, as an observer), and InnoValHC. We also provided scientific guidance and input throughout all project phases.
SwissHTA started with a kick-off meeting at the Ittingen Charterhouse (Kartause Ittingen) in November 2010, which set the stage for the consensus process by discussing the international HTA experience with high-level experts who presented their respective perspectives. After several retreats of the project team as well as public workshops, the team reached a Consensus that was officially endorsed by the participating organizations in October 2011.
The consensus documents were subsequently supplemented by “implementation papers”, recommending a broad technology focus and defined opportunities for stakeholder involvement. Primary evaluation criteria should be driven by the social preferences of the Swiss population, constrained by a prior normative commitment in line with the rights-based legal tradition of Switzerland. The full range of health-related benefits should be evaluated. Assessment of clinical evidence should take into account the level of evidence that can reasonably be expected in a given context, rating the degree of confidence in outcomes in relation to the relevance and the magnitude of the effects observed. Economic viability should be evaluated based on budgetary impact and social cost-benefit ratios. Of note, SwissHTA firmly rejected the idea of incremental cost per quality-adjusted life year (QALY) gained benchmarks as a measure of “value for money”.
SwissHTA illustrates the possibility of a broad-based stakeholder consensus on HTA and offers well-defined evolutionary options. More detailed information regarding project background, workshops and the consensus can be found on the official SwissHTA website.