HTA in Switzerland

The implementation of Health Technology Assessments (HTAs) in Switzerland is inconsistent in terms of the nature, scope, criteria of assessment used and the degree of obligation (implementation of recommendations and decisions) and, in view of the current fragmentation alone, there is room for optimization.

Federal Office of Public Health (FOPH)

At the Federal Office of Public Health (FOPH) there are different procedures and responsibilities (three commissions: ELGK, EAMGK, EAK) for different sectors (service providers and services, equipment and appliances, analyses, packaged medicines, extemporaneous preparations; since 1996). The processes currently established at the FOPH are heavily focused on new products and procedures (including their routine reevaluation) and with regard to the criteria of efficacy, suitability and cost-effectiveness are most intensively elaborated for the pharmaceutical sector and the activity of the Federal Medicines Commission (EAK) concerning this sector.

The identified potential for improvement of the official HTA activities of the FOPH includes the following: consistent separation of assessment, appraisal and decision-making; the greatest possible transparency of process, criteria, recommendations, decisions (and appeals, where applicable) and their underlying reasons; identification of evidence gaps and initiation of measures to plug these gaps, including their enforcement; implementation of HTA results in guidelines for use and quality assurance; innovative “managed entry strategies" for rapid market access without surrendering the demand for evidence; rigorous evaluation of existing technologies including selection criteria for HTA issues and their application.

Medical Board

A much heeded initiative for HTAs in Switzerland came from the Medical Board, initially (as from 2008) supported by Canton Zurich, and since 2011 supported by the GDK, FMH and SAMS. It was launched by the Health Department of Zurich as a pilot project “to help ensure [...] the efficacy, suitability and cost-effectiveness of medical treatments”. At the heart of the method adopted by the Medical Board is the assessment of cost-effectiveness relations by means of a (lower and upper) threshold value, the definition of which requires a “social empirical and consensus finding process” and which reflects the “sense of solidarity” or the willingness to pay for a so-called Quality-Adjusted Life Year (QALY). The Medical Board has so far (as at 15 October 2011) presented five HTA reports.

The identified potential for improvement of the HTA activities of the Medical Board include the following: stronger integration of stakeholders (in terms of both the HTA process itself and its further development); greater consideration of the existing experiences of international HTA institutions and in-depth reference to the status of international developments in the relevant disciplines (including health economics); focus on expectations (“social preferences”) of the insured members (instead of a primary reference to a quasi-utilitarian concept of assessment); consideration of the interactions between the principles of assessment in the context of HTAs and the criteria of efficacy, suitability and cost-effectiveness (and operationalization of these criteria to lend them concrete shape); standards for a differentiated evaluation of new and existing technologies; criteria for the selection of technologies for HTAs and their practical implementation.

Swiss Network for Health Technology Assessment (SNHTA)

Since 1999 the Swiss Network for Health Technology Assessment (SNHTA), which has set itself the goal of promoting the use of HTAs in Switzerland, has served as an association of Swiss stakeholders.