Dr Lou Garrison on HTA Utilization, Opportunities for Growth in the Health Care Marketplace

Lou Garrison, PhD, professor emeritus in the Department of Pharmacy at the University of Washington, explains what is needed to optimize use of health technology assessment (HTA) in the fragmented US health care system.

Efforts to optimize use of health technology assessment (HTA) in the fragmented US health care system require comparative effectiveness research and the necessary budget to meet needs, said Lou Garrison, PhD, professor emeritus in the Department of Pharmacy at the University of Washington. Garrison discusses an upcoming session he will moderate at ISPOR 2021 on HTA integration in the United States.


Can you speak on the role of HTA in addressing pricing and reimbursement challenges?

One of the areas that is coming out is HTA, and the question is about cost concerns, but I would say we're really looking at costs in relation to total value. One of the things that's happened in the last year is the release of a new HTA definition from people from HTAi. HTAi and ISPOR have defined HTA: I think the definition is a multidisciplinary process that determines the value of a health technology at different points in its life cycle.

So, I think we start there and we think about value, and HTA will certainly be discussed. I'm moderating a panel discussion on Wednesday morning that I would recommend to people, where we have a report from an advisory panel I was a member of, led by Darius Lakdawalla, PhD, of USC; Gail Wilensky, PhD, of Project HOPE; and Peter Neumann, ScD, of Tufts Medical Center.

They're going to be talking about a HTA report that is available on the USC website, essentially recommending an HTA body for the United States, a new body, an independent body, and they'll discuss that. I'll be moderating that discussion, and we'll hear a very broad discussion of the pros and cons and some of the challenges.

I would highly recommend that and of course, in many ways, the whole meeting is about aspects of HTA, so it will be touched on in many sessions. I just recommend that to folks, I think they'll find that interesting.

What are some steps to better integrate HTA services in the health care marketplace?

I think that this whole meeting is testimony to the role that HTA and health economics and outcomes research (HEOR) plays in the global health care marketplace. I mean, many countries have HTA agencies, and our whole field starting 25 years ago has been really about refining HTA, HEOR methods, and so on.

Now, the United States is a unique situation—we have this fragmented health care system, we don't have a central payer. So, HTA is accordingly decentralized, if you wanted to put it generously, or in a pluralistic system. So, we have HTA being done by insurance companies and by payers.

We have some centralized HTA, but the important thing to remember is this information about what's going on here is a global public good and that everyone can benefit from it. I would say that the big issue is really the fact that our system is not set up to generate information on real-world outcomes.

We're getting very good at analyzing things at launch, for example, pharmaceuticals, but the issue is who's going to collect the data 5 years after a product is on the market, either a medical service or a pharmaceutical [company]. And we don't have the incentive to do that, which is really the motivation for the Patient-Centered Outcomes Research Institute that was in the Affordable Care Act. But really, in reference to sort of the scope of what is needed, their budget is just a pittance for what we need.

So, at the same time, we can't expect any particular player in the system to provide that information to everybody else. We really need to support that centrally in what's called comparative effectiveness research. And I would say we need that. We have a lot of people with incentive to use that information, but it's not there. So, I would focus on the thing that ISPOR is contributing in the way of the sessions here, for example, on real-world data are about trying to provide that information.