The evolution of heart, lung and liver transplantation services in Australia

The history of health technology assessment in Australia

Objectives:To describe the development and application of health technology assessment (HTA) in Australia.

Methods:Review of relevant literature and other documents related to HTA in Australia.

Results:Most HTA activity in Australia has been associated with provision of advice for the two national subsidy programs, Medicare, and the Pharmaceutical Benefits Scheme (PBS). National advisory bodies established by the federal government have had a prominent role. Assessments from the advisory bodies have had a major influence on decisions related to Medicare and the PBS, and in some other areas. Technologies without links to the national subsidy schemes, and those that are widely distributed, have been less well covered by HTA. To some extent these are addressed by evaluations supported by state governments, but details of approaches taken are not readily available.

Conclusions:HTA in Australia now has a long history and is well established as a source of advice to health decision makers. Challenges remain in extending the scope of assessments, developing more transparent approaches in some areas, and consistently applying appropriate standards.

Australian economic evaluation and government decisions on pharmaceuticals, compared to assessment of other health technologies

In this paper the first theme is the experience with the routine use of cost-effectiveness analysis in decisions by the Australian Pharmaceutical Benefits Advisory Committee on whether drug products should attract a government subsidy. As a second theme, the contrasting experience with several other health technologies is presented, with economic analysis being less frequently used in a system where there is a weaker regulatory framework. Some general points that emerge in both areas are the importance of factors other than economic evaluation in the decision-making process, and the need to make policy and administrative decisions on the basis of limited data. There is limited material available in the public domain on the interaction of economic evaluation and Australian policy on health technologies. It has been necessary, particularly in relation to the case studies presented here, to rely on input from discussion with a number of individuals and on observations made during personal involvement with some of the assessments. It is not possible to offer substantive evidence in support of this material, and indeed firm evidence in the area of impact of assessments on health policy remains difficult to collect.