PD15 Horizon Scanning To Nominate Subsidy Evaluation Topics For Medical Technologies: Early Experience From Singapore

Abstract

Introduction

Horizon scanning (HS) is an early health technology assessment (HTA) method for raising early awareness among policymakers of promising new and emerging health technologies. The Agency for Care Effectiveness (ACE) in Singapore established a HS system in 2019 to complement its HTA process. While the HS system initially focused on cell and gene therapies, this was expanded in 2020 to include medical technologies (MTs). This abstract focuses on the role of HS in nominating MTs for early evaluation to guide subsidy decisions, with the intention of avoiding challenges in altering deeply entrenched practices.

Methods

The ACE methodology for HS aligns with the core principles and methods of international best practice. Generally, MTs addressing national healthcare priorities are tracked. To identify topics for subsidy evaluation, the local registration status of an MT was used as the main selection criterion because of its proximity to the technology’s early diffusion into the healthcare system. MTs with regulatory approval were selected for HTA and subsidy consideration. All nominated technologies were checked against eligibility criteria for HTA and then assessed against a standard checklist for prioritizing HTA topics.

Results

Among the 1,025 MTs tracked by the HS system, 89 were locally registered and nominated for HTA. Following eligibility assessment, 26 topics remained. After the prioritization exercise six topics were shortlisted. To date, two evaluations have been completed to guide subsidy decisions and four topics are undergoing evaluation. Notably, 16 of the 26 eligible topics were excluded due to a lack of sufficient evidence, in terms of both quantity and quality, for evaluation.

Conclusions

HS can be a useful tool for identifying new MTs for evaluation and possible funding prior to further diffusion, but careful selection of the technologies is required to ensure a sufficient evidence base for evaluation. Moving forward, HS can also play a more active role in disinvestment of obsolete or low value health technologies.