Origins and initial aims

In the 1990s, a number of major healthcare systems established formal arrangements to conduct health technology assessment (HTA) of new technologies to inform decisions about the inclusion of those technologies within the group of technologies covered (i.e., provided or reimbursed) by the system. By the early years of this century, formal HTA arrangements of this kind were operating in Australia (The Pharmaceuticals Benefit Committee – PBAC – and the Medical Services Advisory Committee – MSAC), Canada (Canadian Common Drug Review – CCDR – managed by Canadian Coordinating Office for HTA – CCOHTA, now CADTH), the UK (National Institute for Clinical Excellence – NICE) and elsewhere. Since then, other systems have developed similar arrangements and this trend continues, with growing interest in Asia and Latin America as well as North America, Europe, and Australia.

The author worked in the English Department of Health in the 1990s and was involved there in the establishment in 1993 of the NHS HTA Programme and, in 1999, NICE. In this capacity, he was involved in discussions with those responsible for leading NICE in its early years. As a member of the Committee for a New Society for Health Technology Assessment and then founding President of HTAi, he was also involved in international discussions with the leaders of NICE and some similar organisations in other countries. It was clear from these discussions that, while bodies of this kind had frequent interactions with industry, these were focussed primarily on the review of specific products and there were few, if any, opportunities for the leaders of these organisations and industry to discuss the principles of how HTA could best be conducted and used in decisions on products. Discussions with senior staff in industry confirmed this, and that there was an appetite on both sides for an international forum in which such discussions could take place, removed from the pressures (and in some cases, tensions) of discussions of the coverage of specific products.

Organisations consulted from both public and private sectors agreed that the new Society – HTAi – would be the most appropriate body to convene such a forum, given its mission to support and promote the use of HTA around the world as a scientifically based means of promoting the introduction of effective innovations and the effective use of resources in health care, and of promoting discussions between all those involved in HTA whether in the public or private sectors. After extensive informal discussions with the HTAi Board and with potential initial members, the HTAi Policy Forum was formally established in 2004, with an inaugural meeting in 2005. The initial aims of the Forum were stated as:

Meetings and rules of engagement

The intention from the outset was to provide an environment that would promote and support informal discussion (i.e., not restricted to the current formal policy position of the organisations from which participants came). All involved were clear that, while conventional scientific conferences and meetings were of value, they were looking for the Forum to help them have in-depth discussions in an environment where they could speak frankly with one another about challenges in current arrangements and brainstorm ways in which these could be improved. To achieve this, it was agreed that the Forum should hold one main residential meeting a year, running for at least 24 hours in an «off-site» environment. It was further agreed that numbers should be limited and that most of those attending should be senior staff from organisations with direct involvement in the use of HTA in health system decision making that were prepared to commit to at least three years of membership in the Forum and to abide by the Chatham House Rule* The Chatham House Rule states that “When a meeting, or part thereof, is held under the Chatham House Rule, participants are free to use the information received, but neither the identity nor the affiliation of the speaker(s), nor that of any other participant, may be revealed” (see http://www.chathamhouse.org/about-us/chathamhouserule-translations).. The programme of the inaugural meeting was constructed to develop the discussion topic through the meeting with input as appropriate from external experts (including patients and clinicians) but with the majority of time given to structured group and plenary discussion and to informal interactions during breaks and meals.

The inaugural main meeting was held in February 2005. Forum members met for a second, shorter meeting in June 2005 immediately before the HTAi Annual Scientific Meeting, primarily to review progress at the initial meeting and agree to a work plan and topic for the next year. This annual cycle of a main residential discussion meeting in January/February and a shorter «business» meeting at the HTAi Annual Meeting in June has been continued in each subsequent year, though the residential meetings have been extended to run from Sunday evening to Tuesday lunchtime to allow more time to develop and work through an issue in appropriate depth.

Developments between 2004 and 2012

Achievements of the Forum to date

HTAi is currently exploring a formal evaluation of the impact of the Forum. The author meanwhile offers the following personal observations on the achievements, value and impact of the Forum for its members, for the wider HTA community, and for HTAi as an organisation.

Perhaps one of the main achievements of the Forum is that it has thrived and developed in the 7 years since its foundation. The growth of the Forum in itself suggests that it has been providing something of value to its members, to HTAi and to the HTA community and institutions around the world. The five papers derived from the Forum’s discussions that have now been published in IJTAHC represent another important achievement, and the papers summarizing the Forum’s 2011 and 2010 discussions ranked as IJTAHC’s second- and fourth-most read articles of 2011, as reported on the publisher’s website (as of December 2011).

Applications for new membership of the Forum exceed the places available, and only one organisation has left the Forum voluntarily since it was established. These facts suggest that member and potential member organisations see the Form as providing something of value for them. It should be noted here that private sector organisational members pay HTAi $22,000 USD per annum for their membership. Informal discussions suggest that Forum delegates value the Forum as a place where they can develop their personal understanding and networks through open and in-depth discussions with senior colleagues from organisations in their own and other sectors. While the Forum does not produce consensus statements, members report that they find the Forum’s published papers useful in discussions within and beyond their own organisations. And members and their organisations value the opportunity to contribute to international thinking on HTA.

Various developments suggest that the work of the Forum also has value for, and has had an impact on, the wider HTA community. As noted above, the Forum’s papers appear to be being read widely. Again as noted above, the Chair and members of the Forum receive numerous invitations to present the work of the Forum at a wide range of national and international meetings. And the HTAi Policy Forum model has been taken up in a number of related developments in the HTA world, including national developments in Canada and Italy and the work of some other international and national organisations.

HTAi receives a number of benefits from the Forum. Insofar as the work of the Forum is valued by its members and the wider community, HTAi’s own reputation and value is enhanced. HTAi also receives a considerable income from the Forum membership fees which exceed the costs of running the Forum and hence help to fund HTAi’s wider activities. And HTAi’s Annual Scientific Meetings benefit from the Forum’s work, as described above.

Some HTAi members, however, have expressed reservations about the Forum. The author is aware of concerns that membership is restricted and not open to all, and a concern amongst some about the promotion of discussions between public sector HTA organisations and industry. While the latter is a legitimate view, it would appear to contradict one of HTAi’s main aims. The HTAi Board and the Forum have discussed at length the issue of the restricted membership of the Forum. Their view is that the success of the Forum has depended, and will continue to depend, upon membership being restricted to those at the interface of HTA and decision-making who play a leading role in the development of HTA to promote innovation, quality and efficiency in health care, and upon numbers attending Forum meetings being tightly controlled. They have, however, taken a number of steps (described above) to enhance the value of the Forum’s work to HTAi members and the wider HTA community, and a number of further developments are currently under discussion.

Role of Berit Mørland

It is appropriate for a paper in this edition of the Journal to pay tribute to the role that Berit Mørland has played in the formation and development of the HTAi Policy Forum.

As a member of the Committee for a New Society for Health Technology Assessment, Berit was involved in the early discussions of a possible Policy Forum and played an important role in the thinking at that stage. As the first Vice President, and then the second President, of HTAi, she continued to contribute to thinking on the Forum and the implementation and development of the concept. And she gave leadership to the team at NOKC who provided the Scientific Secretariat to the Forum from 2008 to 2011. Berit’s support, connections and standing in HTA in Norway, INAHTA, HTAi and more widely have played a key role in ensuring the success of the Forum to date, and the author is personally grateful to Berit for her support and wise counsel throughout his own involvement with the Forum.