從理論到實戰：HTAi 線上研討會精彩回顧與全球醫療科技評估真實經驗分享

昨晚由 HTAi 主辦的線上研討會「Beyond the ‘Full HTA Report’」圓滿落幕！醫療科技評估（HTA）機構在全球面臨共同的挑戰：如何在「時間壓力、資源限制與科學嚴謹度」之間取得平衡？這場討論延續前兩篇探討「理想定義」與「現實落差」的內容，真實呈現了全球各地的務實做法。

上半場：理論基礎與現實痛點

共同語言的初衷

Tracy Merlin 帶我們回顧了 2014 年國際醫療科技評估組織網絡（INAHTA）訂定 HTA 產出標準的初衷——為了在混亂的名詞中建立「共同語言」（Shared understanding）。

現實中的異質性困境

Barbara Clyne 則透過 10 年的實證數據直擊痛點：現實中的「快速/迷你 HTA」充滿異質性。多數機構為了求快，妥協了方法學或省略了經濟/倫理評估，卻沒有「透明地交代理由」，這為決策帶來了潛在風險。

下半場：全球新興 HTA 系統的務實經驗

下半場的 Panel Discussion 更是整場會議的精華！來自三個不同新興醫療科技評估系統的專家，分享了他們如何在資源與時間的極端壓力下「務實地求生」。

菲律賓：三軌制框架

菲律賓的 Anne Julienne Genuino-Marfori 分享了該國的做法——為了因應不同情況，他們建立了明確的「三軌制」：

  • 完整評估：針對全新科技
  • 加速評估：針對已是標準照護的科技
  • 急迫評估：應對公衛危機

透過清晰的分類與限縮適用族群來控管風險，這是一個系統化的應對策略。

烏拉圭：司法化壓力下的動態快速報告

烏拉圭的 Ana Pérez 點出了拉丁美洲特有的困境——「司法化」。面對病患透過法律途徑要求國家給付高價藥物的壓力，醫療科技評估機構必須產出特定、動態的快速報告來因應訴訟，並將其作為資源「優先排序」的談判工具。

阿拉伯聯合大公國/阿布達比：附條件給付與真實世界證據

阿布達比的 Kefah Al Alqawasmeh 面對長官要求「今天下班前就要決定」的極端時效性，以及針對人工智慧等新科技高度不確定的證據，他們的解方是「擁抱不確定性」：

  • 給予「附條件給付」
  • 強制要求在真實世界生態系中收集數據
  • 一年後重新評估

這個做法既滿足了決策時程，也為證據補強預留了空間。

會議總結：彈性、標準化與透明度

會議最後，兩位主講者的總結非常有力——我們需要保持彈性，但必須伴隨「標準化」與「透明度」。Tracy 更直言：「決策者必須了解並『承擔抄捷徑的風險』，而非將責任全推給產出報告的醫療科技評估機構。」

未來方向：快速 HTA 的品質評估

雖然礙於時間關係，會議未能進行線上 Q&A，但我在會中的一個線上提問——「目前學界仍缺乏專為快速 HTA 設計的品質評估工具」，恰好與講者們最後呼籲建立「新標準」的結論不謀而合！這無疑是未來 HTA 社群亟需共同努力的方向。

結語與反思

感謝講者與所有參與者帶來如此精彩的「繼往開來」對話！在追求「快與準」的決策道路上，您的機構又是如何平衡這些挑戰的呢？歡迎交流！

English version below

From Theory to Practice: HTAi Webinar Highlights and Global Health Technology Assessment Real-World Experience

Last night, the online webinar ‘Beyond the Full HTA Report’ hosted by HTAi concluded successfully! Health technology assessment (HTA) bodies worldwide face a common challenge: how to balance ‘time pressure, resource constraints, and scientific rigor’? This discussion extends our previous exploration of ‘ideal definitions’ and ‘reality gaps,’ showcasing pragmatic approaches from different regions globally.

First Half: Theoretical Foundation and Real-World Pain Points

The Origin of Shared Understanding

Tracy Merlin walked us through the rationale behind the health technology assessment standards established by the International Network of Agencies for Health Technology Assessment (INAHTA) in 2014—to create a ‘shared understanding’ amid the chaos of terminology.

The Heterogeneity Dilemma in Reality

Barbara Clyne, drawing on 10 years of empirical data, highlighted the critical pain point: rapid and mini HTA approaches in practice are highly heterogeneous. Many agencies compromise on methodology or omit economic and ethics assessments in pursuit of speed, yet fail to ‘transparently account for their reasons.’ This creates potential risks for decision-making.

Second Half: Pragmatic Experiences from Emerging Global HTA Systems

The Panel Discussion in the second half was truly the highlight of the conference! Experts from three different emerging health technology assessment systems shared how they ‘pragmatically survive’ under extreme resource and time pressures.

Philippines: Three-Track System Framework

Anne Julienne Genuino-Marfori from the Philippines shared their approach—to address different situations, they established a clear ‘three-track system’:

  • Full Assessment: For entirely new technologies
  • Accelerated Assessment: For technologies already representing standard care
  • Urgent Assessment: For public health crises

Through clear classification and limited scope definition, they manage risk systematically.

Uruguay: Dynamic Rapid Reports Under Judicialization Pressure

Ana Pérez from Uruguay highlighted a challenge unique to Latin America—’judicialization.’ Facing patients using legal pathways to demand government coverage of expensive medicines, health technology assessment bodies must produce specific, dynamic rapid reports to address litigation and use them as negotiation tools for resource ‘prioritization.’

United Arab Emirates/Abu Dhabi: Conditional Coverage and Real-World Evidence

Kefah Al Alqawasmeh from Abu Dhabi faces extreme time constraints with leadership demanding decisions ‘before end of business today,’ plus highly uncertain evidence for emerging technologies like artificial intelligence. Their solution is to ‘embrace uncertainty’:

  • Provide ‘conditional coverage’
  • Mandate real-world evidence collection in the actual healthcare ecosystem
  • Reassess after one year

This approach satisfies decision timelines while reserving space for evidence strengthening.

Conference Conclusion: Flexibility, Standardization, and Transparency

At the end, both presenters’ conclusions were powerful—we need flexibility, but it must be accompanied by ‘standardization’ and ‘transparency.’ Tracy was particularly direct: ‘Decision makers must understand and accept the risks of taking shortcuts, rather than pushing all responsibility onto the HTA agencies producing reports.’

Future Direction: Quality Assessment Tools for Rapid HTA

Although time constraints prevented a live Q&A session, my online question during the webinar—’Currently, academia still lacks quality assessment tools specifically designed for rapid HTA’—remarkably aligns with speakers’ final call for establishing ‘new standards.’ This is undoubtedly a direction where the HTA community urgently needs to collaborate.

Conclusion and Reflection

Thank you to the speakers and all participants for this inspiring dialogue of ‘inheriting and innovating’! In the pursuit of balancing ‘speed and accuracy’ in decision-making, how does your organization navigate these challenges? Feedback welcome!