目标:西班牙在其卫生技术评估(HTA)中纳入了2020年的变化,定价,和药品报销制度,包括发布报告,专家网络的发展,或与利益相关者协商。尽管有这些变化,目前尚不清楚如何应用审议框架,该过程因不够透明而受到批评。这项研究分析了西班牙HTA药物审议过程的实施水平。
方法:我们回顾了灰色文献,并总结了西班牙HTA,定价,和药品的报销过程。我们应用HTA清单的审议过程,旨在评估审议过程的总体背景,并确定所涉及的利益相关者和参与类型遵循循证审议过程的框架,福利包设计框架,旨在优化决策的合法性。
结果:在西班牙HTA中,定价,报销过程的审议是为了交换意见和达成共识,主要是在优先排序期间,评估,和评估步骤。它对公众关闭,在公布的文件中没有明确总结,仅限于卫生部,监管机构,其他部委,以及主要具有临床和/或药学背景的专家。利益相关者的意见只能通过协商来表达。沟通是利益相关者参与的最常用形式。
结论:尽管西班牙HTA评估药物过程的透明度有所改善,与利益攸关方参与和执行审议框架有关的方面需要进一步关注,以进一步实现这一进程的合法性。
OBJECTIVE: Spain incorporated in 2020 changes in its health technology assessment (HTA),
pricing, and reimbursement system for medicines including publishing
reports, development of networks of experts, or consultation with stakeholders. Despite these changes, it is unclear how deliberative frameworks are applied and the process has been criticized for not being sufficiently transparent. This study analyses the level of implementation of deliberative processes in HTA for medicines in Spain.
METHODS: We review the grey literature and summarize the Spanish HTA,
pricing, and reimbursement process of medicines. We apply the deliberative processes for HTA checklist, developed to assess the overall context of the deliberative process, and identify the stakeholders involved and type of involvement following the framework for evidence-informed deliberative processes, a framework for benefit package design that aims to optimize the legitimacy of decision making.
RESULTS: In the Spanish HTA,
pricing, and reimbursement process deliberation takes place in order to exchange viewpoints and reach common ground, mainly during the prioritization, assessment, and appraisal steps. It is closed to the public, not clearly summarized in published documents and limited to the Ministry of Health, the regulatory agency, other Ministries, and experts with mostly clinical and/or pharmaceutical background. The views of stakeholders are only represented through consultation. Communication is the most commonly used form of stakeholder engagement.
CONCLUSIONS: Despite improvements in transparency of the Spanish HTA process for evaluating medicines, aspects related to stakeholder involvement and implementation of deliberative frameworks need further attention in order to achieve further legitimacy of the process.