HTAi 2022 Asia Policy Forum Program

HTA Capacity Building in Asia: Towards One Goal HTAi Asia Policy Forum November 2 – 4, 2022

Welcome Dear Colleagues, The 10th Asia Policy Forum for 2022 sees the return of a face-to-face format in Singapore. Much has been learnt from the experience of the pandemic. New virtual technologies have been well utilised but they rely on well-established relationships being in existence. In Singapore we have the chance to re-establish old friendships and develop new ones. The topic we are covering on capacity building is vital for all organisations. HTA skills and staff who understand their implementation are vital if real progress is to continue to develop within our region. We will hear from agencies, universities and industry on how they are dealing with providing well-resourced organisations to handle the challenges of HTA. COVID-19 has highlighted deficiencies in the global response to provide rapid, reliable and appropriate reactions to a new, but predictable, occurrences impacting global health. Agile, lateral thinking will be required in the future when the next challenge arrives. We need the capacity to manage such eventualities wisely and effectively. The aim of the Policy Forum is for representatives from industry and health technology agencies in Asia to come together to discuss mutual problems and issues in a respectful way. As well as the background material and keynote presentations, there will be ample opportunities for breakout groups to explore issues and report. At the end of the meeting a brief communique will be produced, followed by a publication for the International Journal of Technology Assessment in Health Care (IJTAHC) and a proposed panel session at the HTAi Annual Meeting in Adelaide in 2023. Finally, I would like to thank all those on the Organising Committee and the Secretariat who have contributed in developing the meeting program and the organisation of the meeting, and those who presented, facilitated or reported in the breakout groups. Special acknowledgement goes to Linda Mundy for providing scientific rigor for the meeting. I wish you all every success for our three days in Singapore. Regards, Professor Guy Maddern Chair, HTAi Asia Policy Forum 2

Meeting Information Meeting Information The 2022 HTAi Asia Policy Forum will take place November 2 – 4, 2022 in Singapore. Registration will take place from 10:30 a.m. to 11:00 a.m. on Wednesday, November 2, 2022, outside the Lavender Ballroom. Topic The topic for the meeting is: “HTA Capacity Building in Asia: Towards One Goal” Venue Information Meeting hotel Hotel Fort Canning 11 Canning Walk Singapore 178881 Phone + 65 6559 6769 Email: [email protected] Website: https://hfcsingapore.com/ Hotel Fort Canning is a luxurious and award-winning conservation hotel tucked within 18 hectares of lush greenery in Fort Canning Park. Considered one of Singapore’s iconic heritage hotels, Hotel Fort Canning bears a storied past that dates back to the early 20th century, with the building itself a former British military administration site. Today, the hotel’s architecture continues to retain much of its colonial glamour, combining it with modern elements of the surrounding parklands - making Hotel Fort Canning one of Singapore's heritage hotels situated within a historical hilltop park. Check-in is available from 15:00 on your day of arrival to request an early check-in, please contact the hotel. Check-out is 12:00 on the day of departure. Breakfast is included in your room rate and will be available at your leisure from 7:00 to 10:30 in The Salon restaurant, located on level 2. Dress Code Business casual 3

Meeting Information Sharing Information HTAi would like to encourage Forum members to share their thoughts and experiences on social media. However, please keep in mind the HTAi Asia Policy Forum is held under the Chatham House Rule so neither the identity nor affiliation of the speaker(s), nor that of any other participant, may be revealed. Official hashtag: #2022APF Social media handles: • Twitter: @HTAiOrg • LinkedIn: Health Technology Assessment International (HTAi) • Facebook: @HTAiOrg Transportation Options The Hotel Fort Canning is a 20-minute drive from the Singapore Changi Airport via car, taxi, or airport transfer. Taxis Taxis are available for hire at the taxi stands in the Arrival areas of Terminals 1, 2 and 3. A ride to the city takes about 30 minutes and costs between S$20 and S$40. All fares are metered. There is an additional Airport Surcharge for all trips originating from the Airport: • Mon–Sun (5:00PM–11:59PM): S$8 Airport Surcharge • All other times: S$6 Airport Surcharge • Midnight surcharge (12:00 AM–6:00 AM): 50% of final metered fare • Peak-hour surcharge (6:00 AM–9:30 AM, Mon–Fri and 6:00 PM–12:00 AM, Mon–Sun): 25% of final metered fareRide App Services Airport Transfer 24-hour Ground Transport Concierges (GTC) offers convenient transfers from Changi Airport to your destination. Transportation options include: • 4-seater vehicle (S$55.00 per trip to any destination in Singapore) • 7-seater vehicle (S$60.00 per trip to any destination in Singapore) • City Shuttle (S$10.00 per adult or S$7.00 per child below 12 years of age) to selected downtown areas. The City Shuttle departs at 0700H, 0800H, 0900H, 1000H, 1700H, 1800H, 1900H 4

COVID-19 Policy Meeting Information HTAi is committed to providing attendees at all Society events with the best possible health practices during the COVID-19 pandemic. As a result, HTAi will ensure that basic steps are taken to reduce the risk to event attendees from this communicable disease. The COVID-19 pandemic is continually changing as are public health guidelines. HTAi will consider the possibility of additional restrictions and be prepared to amend this policy accordingly. HTAi will ensure that all attendees, including speakers, are aware of any newly required or recommended public health actions/ measures in effect at the location of their event. HTAi supports vaccination as protection against the spread of COVID. All participants at our events are therefore expected to comply with the rules regarding vaccination and testing (and additional measures as and if required) in place at the location of HTAi events. All event attendees are required to monitor their health prior to attendance and are asked NOT to attend the event if they are experiencing COVID-19 symptoms and/or are feeling unwell. Any individual who has or is suspected of having COVID-19 is required to inform the meeting organizer. Should HTAi become aware of the situation, it shall inform the event attendees. Timely reporting can help minimize the spread of COVID-19. HTAi will make every effort to protect the privacy of the individual(s). HTAi will take no responsibility and will not reimburse attendees for any COVID-19 test (rapid, PCR or antigen) associated with attendee travel and event registration fees to an HTAi event, any insurance purchased or any expenses incurred as a result of mandatory quarantine or isolation. The individuals who do not comply with this Policy will be asked to leave or not to enter the event space. Masking Wearing a mask is a personal choice, however, it is NOT REQUIRED by Public Health in public indoor settings. Masks are required on public transit and healthcare facilities. Lanyard Traffic Light Colour Legend To gauge attendee comfort levels with physical proximity and contact, we will be providing coloured lanyards at the registration desk on-site at the Forum. Red = No physical contact Yellow = Still cautious (elbow bump, fist bump, etc.) Green = Handshakes, high fives, and hugs 5

Meeting Information COVID-19 Testing Options For Travellers Singapore Swab & Travel 14 Scotts Rd, Far East Plaza, #05-89 Singapore 228213 Opening Hours: 9am – 6pm, 7 days +65 8757-SWAB (87577922) [email protected] Booking is also available through their website: https://www.swab.sg/contact TravelSwap People’s Park Centre 101 Upper Cross Street, #03-11, Singapore 058357 Operating Hours Everyday, 8 am – 11 pm Call/Whatsapp: +65 8909 4193 Email (for non-urgent enquiries): [email protected] Singapore Arrival Card (SGAC) Please note that all travellers must fill in the SGAC declaration up to 3 days before arrival. Please note that there have been some scam attempts reported, and you will not be asked to pay to process this card. Hospital Tour (November 2) National Centre for Infectious Diseases (NCID) 16 Jln Tan Tock Seng, Singapore 308442 Time: 11:00 – 14:00 A private coach has been arranged from Hotel Fort Canning to the National Centre for Infectious Diseases (NCID) We ask that you join us in the hotel lobby at 11:00. Please note the bus will leave the hospital no later than 11:15. 6

Networking Reception (November 2) Meeting Information Grande Marquee – Hotel Fort Canning Time: 19:00 onwards Food and Beverages to be provided Social Dinner (November 3) Empress 1 Empress Pl, #01-03 Asian Civilisations Museum Singapore 179555 Time: 18:00 - 20:30 Please note: If you would like to take the private coach from Hotel Fort Canning to Empress, we ask that you join us in the hotel lobby at 17:30. Please note the bus will leave the venue at 17:45. For those who choose to walk (20 min.) to Empress from Hotel Fort Canning, we will have maps available at the registration desk. 7

Agenda Agenda Wednesday 2, November Time Activity Speaker(s)/Facilitator(s) 10.30 – 11.00 11.15 – 14.00 Registration (Hotel Fort Canning) 14:00 – 14.45 14.45 – 15.00 Tour to the National Centre for Infectious Diseases ALL (NCID) (bus departs hotel lobby at 11:15) 15.00 – 15.30 Networking lunch ALL 15.30 – 16:00 16.00 – 16.15 Welcome, Housekeeping & Introductions Guy Maddern 16.15 – 18.15 Wija Oortwijn 16.15 – 17.15 Keynote Presentation: Update on the Use of Real- Dr. Hwee-Lin WEE 17.15 – 18:00 World Data and Real-World Evidence to Support Drug 19.00 – 21.00 Reimbursement Decision-Making in Asia The REALISE project Q&A ALL Networking Coffee & Tea Break ALL What’s Keeping Me Up At Night session WKMUAN Breakout Sessions ALL Delegates will be surveyed prior to APF 2022 to identify their most prescient concerns and allocated into like-minded groups Report back and discussions ALL Networking Reception in the Grand Marquee Room (Hotel Fort Canning) 8

Thursday 3, November Agenda Time Activity Speaker(s)/Facilitator(s) 08.00 – 08.30 08.30 – 08.40 Registration ALL 08.40 – 08.55 Networking Coffee & Tea 08.55 – 09.25 Day 1 Overview Guy Maddern 09.25 – 09.45 Linda Mundy 09.45 – 10.15 Welcome from Health Ministry Dr. Janil Puthucheary 10:15 – 10:45 10.45 – 11.15 Overview of how to set up and build an Kwong Hoe Ng 11.15 – 11:45 HTA agency from scratch – Singapore’s ACE experience 11:45 – 12:15 12:15 – 12:30 Q&A ALL 12.30 – 13.30 A series of short presentations and a Saudamini Dabak, Thailand 13.30 – 15.00 panel discussion from agencies around Izzuna Mohamed Ghazali, 15.00 – 15.15 capacity building issues Malaysia 15.15 – 16.15 Grace Huang, Taiwan 16.15 – 16.25 16.25 – 16.35 Q&A ALL 18.00 – late Networking Coffee & Tea Break ALL A series of short presentations and a Vanessa Xavier, Sanofi panel discussion from industry around Joice Valentim, Roche capacity building issues Virginia Priest, Boston Scientific Q&A ALL Description of breakout group topics Guy Maddern 2 groups discussing each topic: 1. HTA staff: training, recruitment, development, retainment 2. Funding & Resourcing Capacity Building 3. External stakeholders: industry, Universities (MOOCS) Networking Lunch ALL Breakout Sessions ALL Networking Coffee & Tea Break ALL Report Back Discussion ALL Wrap up Guy Maddern Group Photo ALL Social Dinner (bus departs hotel lobby at 17:45, and departs Empress at 20:45) 9

Agenda Friday 4, November Time Activity Speaker(s)/Facilitator(s) 08.30 – 09.00 Networking Coffee & Tea ALL 09.00 – 09.15 Day 2 Overview Guy Maddern Linda Mundy 09.15 – 09:45 HTAi's focus on capacity building Wija Oortwijn 09.45 – 10.00 Q&A ALL 10.00 – 10.45 Networking Coffee & Tea Break ALL 10.45 – 12.15 Each agency to present 10 mins on what HTA courses are available locally and what their gaps are, how the APF can help 12.15 – 13.00 Networking Lunch ALL 13.00 – 14.15 Development of roadmap ALL 14:15 - 14:30 Group workshop on developing elements of the 14.30 roadmap to building and nurturing HTA capacity in the Asia region Closing remarks and thoughts on topic for 2023 Asia Policy Forum Departure 10

Background Paper HTAi Asia Policy Forum Background Paper HTA Capacity Building in Asia: Towards One Goal Singapore 2-4 November 2022 \"Building capacity dissolves differences. It irons out inequalities.\" Abdul Kalam 11

Background Paper Executive summary Although health technology assessment (HTA) is considered by many as an essential element of priority-setting in health care, in many countries the capacity to conduct and use HTA in the healthcare decision-making process is still lacking. Factors contributing to this lack of capacity are, first and foremost, the shortage of skilled technical HTA practitioners. The causes for the scarcity of workers are many; however, the lack of funding for HTA, often stemming from a lack of political willingness to mandate the use of HTA, is a critical factor. This may be due to a lack of understanding of the value of the HTA process and how HTA outcomes are interpreted and used in the healthcare decision-making process. Educating all stakeholders on the value of HTA will ensure that the HTA is recognized as a transparent, equitable process to ensure access to health care for all. An increased demand for HTA should create a supportive environment to foster HTA activities. What capacity building looks like and how it is implemented will vary from jurisdiction to jurisdiction, but any measures must be ‘owned’ by local stakeholders in equal partnership with the external players supporting the process. From the pre-meeting survey it is clear that there are some agencies, such as Cambodia, that would benefit greatly from capacity building measures, whilst there are others like ACE in Singapore, that have staff qualified with all the technical skills to conduct HTA, but just not enough human resources to meet the growing demand for HTA. On the other hand, industry delegates report extensive investment in building capacity within their companies and a willingness to reach out to the region to develop capacity and understanding of the HTA process. Some HTA challenges may be mitigated by networking and by building HTA systems through the pooling of resources across countries. Finally, by looking at some of the successes and challenges of capacity building in the region that were nominated by the APF delegates, it may be possible to construct a roadmap for future capacity development in the region. 12

Introduction Background Paper Health Technology Assessment (HTA) is a multidisciplinary process that not only systematically synthesizes evidence describing the efficacy, clinical effectiveness, safety and cost-effectiveness of a health technology (drugs, devices, vaccines, health interventions), but also considers the ethical, legal and social implications of a technology.1 HTA is a well-recognized and methodologically robust priority-setting tool used to support public reimbursement and coverage decision-making, ensuring the efficient use of limited healthcare resources. In its support for the drive to achieve universal health care (UHC) in South-East Asian region, the World Health Organization (WHO) urged member states to pursue the HTA agenda as a priority.2 With the commitment to implement and achieve UHC, especially in low to middle income countries, an increased demand for HTA personnel and proficiency across academia, government and industry has also been observed.1, 3 Although the foundations of HTA infrastructure is in place in many countries in the region, there remains a gap between supply and demand of HTA capacity as the need for HTA grows.2 In addition to needing a good understanding of the health system in which they are working, HTA researchers need qualifications in epidemiology, biostatistics, evidence-based medicine, amongst others, which enable them to search for and critically appraise the literature, synthesize the evidence as part of a systematic review or meta-analysis and conduct economic analyses, as well as having an understanding of the social, cultural, legal and ethical implications of their research. In addition to the skills mentioned above, an ideal HTA team may include information specialists, policy specialists and health economists, all of whom may, or may not, have a clinical or scientific background.4 As discussed in previous Asia Policy Forums (APF), capacity in the Asia region has continued to be a barrier for conducting HTA, especially the recruitment, training and retention of skilled HTA practitioners as countries either continue to develop or move towards UHC. During the 2017 APF, Vietnam reported limited technical capacity to undertake HTA to assist in the prioritization of health services to add to its benefits package. At the same APF, countries such as Singapore, the Philippines, Malaysia, Thailand, China and Vietnam also reported that one of the key barriers to using real world data to inform decision-making was the lack of capacity to enable information and data sharing.5 Interestingly, many of the 2017 industry delegates reported that their companies were involved in a range of capacity building and development activities in conjunction with HTA agencies in order to support the development of robust evidence generation infrastructure in the region (Figure 1). Most companies reported being involved in capacity building in the training and development of skills in HTA and health economics methodology using a collaborative approach including investing in infrastructure, advocating the use of databases, conducting early assessments and pilot projects, supporting third parties such as universities and think tanks.5 During the 2018 APF, the Philippines reported that their limited technical capacity to assess uncertainty around economic analyses prevented its use as a criterion for implementing alternative funding mechanisms such as managed entry schemes.6 In the past, China reported that despite a concerted effort to build HTA capacity, HTA was not a mandatory component of the health policy decision-making process, with new health services added to benefit packages based on local experience rather than an evidence-based approach.7 Challenges presented by the COVID-19 pandemic were discussed by the APF in 2021, with the lack of HTA capacity identified as a pressing issue, especially when many COVID-19 related interventions (drugs, vaccines and interventions) had to be evaluated and approved with limited evidence within a short timeframe.8 13

Background Paper Figure 1 The percentage of companies reporting capacity building activities in the Asia region (2017 APF)5 Government health departments in the region have long recognized HTA as a tool for the efficient and transparent allocation of resources, ensuring the sustainability of health systems that are at various stages of developing and implementing UHC.9 Strengthening priority setting by building HTA capacity in the region has been identified as critical for the formulation of benefit packages that can deliver equitable, high-quality and affordable health care for all. Political will, leadership and legislation have been identified as important and necessary steps in order to advance the use of HTA in the decision-making process for public health resource allocation. Capacity building requires political will to implement HTA processes into everyday decision-making, and to fund the training, development, and retention of professional staff with the necessary expertise.10 Barriers such as a lack of awareness of HTA, in addition to the shortage of skilled HTA researchers, limited information technology infrastructure and low political support (or political agendas) have limited the capacity to conduct HTA in some countries. Recognizing the link between evidence, policy and practice legitimizes the HTA process, further embedding HTA in the policy decision- making process, and in so doing, fuels the demand and need for capacity building to deliver high quality HTA.11 The lack of technical HTA capacity combined with limited access to local epidemiological data may result in benefit packages that are not informed by evidence-based decision-making, resulting in inefficient and inequitable healthcare systems, which is opposite to the desired goals of UHC.11 The development of HTA capacity where it is lacking will better inform decision-making enabling the more effective, efficient and equitable use of health resources, which will, in due course, result in better health outcomes for the population as a whole.3 14

What is capacity building? Background Paper The terms capacity building and capacity development are often used interchangeably in the literature, with some stating that capacity development infers that capacity already exists in the system and can therefore be strengthened by developing existing skills and knowledge, whereas capacity building suggests a lack of existing capacity.12 Although the term capacity development is preferred by most institutions, for the sake of simplicity and consistency with HTAi*, this paper will use the term capacity building. Capacity building is a term that is applicable across a myriad of fields including education, industry, agriculture, urban development, and health, with each sector likely to have their own definition based on their specific needs and local context. Capacity building may be simply defined as 'planned development of (or increase in) knowledge, output rate, management, skills, and other capabilities of an organization through acquisition, incentives, technology, and/or training'. However, the United Nations Development Programme (UNDP) has defined capacity building as that ‘through which individuals, organizations and societies obtain, strengthen and maintain the capabilities to set and achieve their own development objectives over time.’13 The UN’s Sustainable Development Goal 17 notes that an essential element of capacity building is that sustained, long-lasting transformation is achieved by changing mindsets and attitudes over time, not by achieving single tasks in isolation.14, 15 Capacity building is a broad and complex undertaking, implying change at multiple levels, and can through the transfer of knowledge and skills at the local (contextualized) level empower people and improve the effectiveness and sustainability of organizations such as the health system.16 Capacity building is a term that can be applied at the individual, organizational and environmental level, with all three levels being interconnected and reliant on each other (Figure 2): • At the individual level– the process of improving an individual’s skills, experience and knowledge by providing access to information, knowledge, education, training as well as hands-on experience that enables them to perform more effectively; • At the organizational level- improving organizational performance and effectiveness by strengthening internal structures, policies and procedures through strategies, plans, processes and procedures, not only within organizations but between different organizations and sectors (public, private and community); and • At the environmental or system level - improving policy frameworks to enable organizations, institutions and agencies at all levels and in all sectors to enhance their capacities by addressing economic, political, environmental, legal and social factors in a coherent and mutually reinforcing fashion. The enabling environment sets the ‘rule book’ and, therefore, the overall scope for capacity development.13, 15 Access to resources and experiences that develop an individual’s capacity are shaped by organizational and environmental factors, which in turn are influenced by the degree of capacity development in each individual.13 It should be noted that the UNDP places an extra category between Organizations and Environment – Networks, either within a country or as an important aspect of regional capacity building between countries. Networking may be as simple as collaboration between institutions on specific projects or general networking opportunities such as that offered by collaborative organizations like HTAsiaLink, which facilitates countries across the Asia region to share their HTA experiences, learnings and resources, and provides opportunities to share technical and methodological know-how.17-20 Most important of all, networks such as HTAsiaLink build interpersonal relationships among member countries, fostering a willingness to collaborate, mutual trust, respect, and open communication.19 * The terms of reference for HTAi’s Scientific Development & Capacity Building Committee is to streamline the scientific direction of the Society, providing guidance and developing the HTA capacity around the world and build up an efficient learning environment within HTAi. 15

Background Paper Figure 2 The inter-related 3-dimensions of capacity building 21 Recently, HTAi’s Scientific Development & Capacity Building (SDCB) Committee set out to develop an HTA- related definition of capacity building that was more relevant to and considered the broad range of HTA- related stakeholders and activities. The SDBC Committee concluded that a simple, HTA-specific definition of capacity building was not currently feasible due to the breadth of HTA activities and the different levels of development of HTA across health systems (nascent to mature). The Committee recommended that an “operationalization menu” be developed, a collaboration and opportunity that members of the APF may wish to participate in, to ensure that capacity building issues specific to the region are reflected in any future work of HTAi in this area.22 Capacity building principles There is no single approach to capacity building to support effective priority-setting, but rather a spectrum of activities that identifies roles and skill sets of all involved in the process.17 Important factors for the success of capacity development include: • political will – government participation and ownership, leadership and vision; • locally demand-driven agendas and the involvement of stakeholders at all levels; • effective technical and financial support, with the right incentives in place; • long-term continuity; • an enabling environment.23 The first principle of capacity building is that it should exploit and develop existing local capacities with a locally driven context and agenda. Ideally, a program of capacity building should be sustained and maintained over time, offering opportunities for ongoing learning and change.24 Strong partnerships with external players, such as funding agencies (e.g. the World Bank) or, as in the case of HTA, agencies such as NICE International, can offer support, advice or help create the right external incentives for capacity building processes. However, local players in whom capacity development is being targeted, should have the ultimate responsibility for identifying their needs and then designing, managing and driving the process of change. That is, what capacity building looks like and how it is implemented must be ‘owned’ by local stakeholders in equal partnership with the external players supporting the process.13 16

A good example of a strong partnership is the capacity building initiative developed by the UK’s National Background Paper Institute for Health and Care Excellence (NICE) International and Thailand’s Health Intervention and Technology Assessment Program (HITAP). In 2008, NICE International was established to offer: “Advice on building capacity for assessing and interpreting evidence to inform health policy and on designing and using methods and processes to apply this capacity.” Together HITAP and NICE developed a framework that would promote structures and processes to guide health policy and build HTA capacity in countries in the Asia region that were moving towards UHC. The aim of this initiative was to foster the transfer of expertise and knowledge to several countries in the region with the goal of exposing decision makers and technical staff to evidence-based policymaking. Successful projects using this approach include those in Myanmar (improving maternal and child health), the Philippines (an expanded immunization program) and Vietnam (stroke management). The success of these collaborative capacity building projects depended on a demand-driven focus on local policy agendas and building links not only across institutions but between institutions and health policy-makers.3 'the principle that people are best empowered to realise their full potential when the means of development are sustainable – homegrown, long-term, and generated and managed collectively by those who stand to benefit' UNDP13 Capacity building in HTA HTA capacity building is more than simply training staff in the technical and methodological aspects of conducting HTA. The context for capacity building, and the ability to design processes and manage change will differ markedly between countries and will depend on pre-existing and binding constraints, such as political buy in and governance.13 HTA capacity building at the Individual level HTA stakeholders at the individual level include the “doers” – those individuals who are involved in conducting HTA, such as academic and industry researchers. Although the organizational and environmental levels are critical for HTA to be embedded into health systems, capacity building at the individual level is essential for successful HTA, giving individuals the means to increase and improve their technical skills, experience and knowledge in order to conduct, interpret and use HTA effectively. Other important stakeholders at the individual level include patients, caregivers and clinicians who are interested and engaged in the HTA process as a means of accessing new health care technologies.22 Essential ‘hard’ technical skills for the producers of HTA include, amongst others, research methods in HTA, identifying and implementing evidence, data gathering and management, and using evidence to inform policy; however, the cultivation of ‘soft’ skills such as effective writing and communication are also of great value.25 Networking and collaboration at the individual level is also key for the transfer of knowledge and skills transfer, with individuals who have acquired skills in how to conduct and then interpret HTA able to mentor others, in so doing, growing capacity.22 HTA capacity building at the Organizational level HTA capacity building at the Organizational level is context dependent and must consider organizational structures, policies and procedures of HTA, encompassing both within organization relationships (e.g. a HTA agency embedded within a university or hospital) and relationships between organizations (e.g. HTA agency/university and the Department of Health).22 The recent survey of ASEAN countries by Sharma et al (2021) reported that local technical expertise in conducting HTA is concentrated amongst researchers and academics in universities or in nodal agencies. Although universities can serve as centers of capacity building 17

Background Paper and HTA knowledge brokers through research, data collection and analysis, and innovation, a lack of political support can result in a lack of funding for these centers, which in turn reduces their ability to train more HTA staff. Apart from HTA technical capacity, institutional arrangements are critical in ensuring that a credible and transparent assessment process can be established to translate evidence into policy in a local context.2 It is therefore critical that strong links be developed between HTA organizations and health policy-makers so that decision-makers have confidence in the quality of the HTA process and the relevance of the HTA product to the end user.22 In addition, government funding to enable these institutions to maintain resources such as information technology infrastructure is critical to not only access and utilize data and the evidence base but also to access training opportunities for HTA staff.25 HTA capacity building at the Environmental level Stakeholders at the environmental level include those who have the responsibility of implementing HTA, such as health policy-makers in government (primarily health departments), regulatory and procurement agencies, health insurance companies and donor organizations. However, other important stakeholders include the community as a whole (not at the individual patient level), the media, and health professional bodies.22 Although most HTA practitioners (and policy-makers to some degree) agree that public consultation and involvement in priority setting should be encouraged, in practice, this rarely occurs. Advocacy may be a more effective role for community stakeholders, harnessing the power and reach of the media and holding policy- makers to account for their decision-making to ensure equity of access to high-quality health care.25, 26 One of the main priorities of HTA capacity building at the environmental level in a health care context means putting in place the political will, governance and policy structures to support HTA capacity to inform decision-making and in so doing promote an equitable, efficient and high-quality health system.17 Wu et al (2022) cited a good example of a lack of understanding and awareness of the HTA process by those tasked with implementing the results of HTA, reporting that too often governments focused on, and valued, budget impact analyses of new health technologies over the more complex cost-effectiveness analyses that estimate value for money rather than affordability.1 In a recent survey, Sharma et al (2021) reported that although most countries in the region had HTA agencies despite a lack of an explicit remit or legislation mandating the use of HTA, the lack of political will and support prevented the institutionalization and widespread integration of HTA into health systems. Political support, as opposed to political interference, was viewed as crucial to drive the translation and adoption of HTA recommendations into policy.2 Finally, it is especially important that all stakeholders at the Individual, Organizational and Environmental levels not only understand the value of, and the need for, priority-setting in health care but also have the capacity to understand the HTA process and how HTA outcomes are interpreted and used in the healthcare decision-making process.2, 22 25 Appendix 2 catalogues some HTA-specific capacity building initiatives. Pre-meeting surveys A global survey on HTA was conducted by the WHO in 2020/21 which aimed to measure not only the utilization and scope of HTA in public sector decision-making but also the institutional capacity to support HTA as well as the requirements for strengthening HTA capacity. A total of 127 Member States from all six WHO regions† responded to the survey, representing an overall response rate of 65.5 percent. The survey asked questions about the purpose of HTA performed in each country (inclusion in benefits package, pricing † Response rates: European Region (EUR 66%), South-East Asian Region (SEAR 91%), Eastern Mediterranean Region (EMR 57%), Western Pacific Region (WPR 56%), American Region (AMR 66%) and African Region (AFR 68%). 18

of technologies etc.), the type of technologies assessed (drugs, devices etc.), and also the elements included Background Paper in each HTA (e.g. ethical, equity and feasibility issues). In addition, questions around HTA capacity were asked – the number of staff involved in HTA, the affiliation and qualifications of these staff, and where requests for HTA came from (e.g. Ministry of Health).27 Of interest to this forum were the questions relating to the strengthening of HTA capacity. The main barrier for producing HTA and using HTA findings in decision-making was a lack of suitably qualified human resources. All regions reported similar barriers to HTA: lack of funding for conducting HTA and a lack of information/data or knowledge of HTA methods (Figure 3). Figure 3 Barriers to HTA production27 A lack of institutionalization of HTA and awareness about the importance of HTA were cited as significant barriers to incorporating the results of HTA in decision-making by many countries. Interestingly, fewer countries reported political support and a mandate from a policy authority as obstacles for using HTA in health care policy decisions (Figure 4).27 Figure 4 Barriers to using HTA to inform decision-making in health care policy27 19

Background Paper Of significance to the discussions at this forum, 38% of respondents ranked ‘higher education’ as the top need for further development and capacity building, followed by internal staff training (Figure 5).27 Individual country profiles can be accessed via this link. Figure 5 HTA capacity building support required by countries27 When responses were broken down to the 10 countries from the Southeast Asia region that answered the survey, responses did not differ greatly from the global picture. Qualified human resources were cited as the biggest barrier in terms of producing HTA and then being able to use HTA in the decision-making process. Most respondents (60%) cited a lack of higher education and Masters in HTA as the biggest issue in supporting the implementation of HTA. Figure 6 further breaks down the areas identified by respondents that would most benefit from capacity building activities. 27 Figure 6 Areas that would most benefit from capacity building activities27 20

To identify some of the issues and challenges around HTA capacity specific to the Asia region, pre-meeting Background Paper surveys of APF industry and agency members were conducted, with the results summarized below. It is hoped that the results of these surveys will act as a prompt for further discussion and exploration during the forum, with the aim of developing a ‘roadmap’ to strengthening HTA capacity in the region. Summary of the results from the agency survey HTA has been one of the main priority-setting tools used by health policy-makers to inform evidence-based decision-making on the quality, safety and cost-effectiveness of new healthcare technologies. As discussed in previous Asia Policy Forums, HTA capacity building in the Asia region has continued to be an issue, especially the training, recruitment, and retention of skilled HTA practitioners as countries continue to move towards universal health care. This survey was intended to identify some of the issues and challenges around HTA capacity in the region to inform discussions at the 2022 APF annual meeting. A copy of the survey questions can be found in Appendix 1. A total of nine HTA agency participants responded to the survey in full, representing Cambodia, China‡, Indonesia, South Korea, Malaysia, the Philippines, Singapore, Taiwan and Vietnam. The majority of HTA agencies are embedded within their respective Departments of Health (DOH), and all are public sector agencies. Only one agency reported being embedded in a university (Fudan University, Shanghai, China)§. Of the eight agencies embedded in their DOH, only three reported having strong links with a university: Taiwan, Malaysia and Indonesia. A lack of engagement with universities may represent an opportunity to develop capacity building activities. The main source of funding for all HTA agencies was their respective Departments of Health (DOH). Four agencies were wholly funded by the DOH, and of these, three reported conducting HTA only for the DOH: Taiwan, the Philippines, and Singapore. Malaysia, although only funded by the DOH also conducted HTA on behalf of other government departments and regulators. All other agencies were funded in part by the DOH, and all conducted HTA on behalf of the DOH; however, additional funding was received from other sources, and HTA was conducted for these funders (Figure 7and Figure 8). ‡ Of two HTA agencies in China (Shanghai and Beijing), Shanghai responded to this survey. § India reported being embedded within a university - Tata Institute of Social Sciences; however, survey response was incomplete and was removed from results 21

Background Paper Figure 7 The source of funding for HTA agencies Figure 8 Who HTA agencies conduct HTA for 22

Five of the nine (55.6%) agencies currently assess all types of health technologies: drugs, medical devices, Background Paper diagnostics, vaccines, surgical procedures, health screening programs and public health programs, whilst Taiwan assessed all of these technologies with the exception of diagnostics. Cambodia reported only assessing public health programs, as did Vietnam, with the addition of drug assessments. Singapore reported assessing all technologies except for health screening programs and public health programs. When asked about the limitations of HTA infrastructure in their country, responses were fairly consistent across the region. A lack of expertise in the implementation of HTA was cited by six countries, with five of these countries reporting that a lack of technical expertise to conduct HTA and a lack of funding for HTA development were also major issues. Interestingly, only Cambodia and Indonesia reported that a lack of HTA training was a limiting factor. A lack of political support for using HTA in health policy decision-making was only reported by three countries: Indonesia, Vietnam and South Korea. The Philippines identified a lack of research networks with universities to expand capacity for assessments as a limiting factor, and Vietnam cited a lack of local data to support HTA studies. Singapore noted that technical expertise is not an issue, but they are limited by insufficient manpower to be able to carry out more HTA evaluations and related workstreams. Similarly, Malaysia has an inadequate number of experts, and that expertise in this highly skilled area needs to be strengthened. Although staffing levels (technical and non-technical) varied from country to country, most countries reported the number of staff were below capacity (77.8%), with only Taiwan and Vietnam reporting that they felt staffing levels were just right. Retainment of staff didn’t appear to be an issue, with most countries reporting that staff were employed for more than three years, with only Taiwan and the Philippines reporting an average employment period between 1-3 years. When asked to think about the factors that made retention of HTA staff difficult, the most common reason cited (6/9 (66.7%) agencies) was a stressful work environment. This factor appeared to fulfil a circular argument summed up by Singapore’s comment that due to insufficient staffing levels, ACE** has not been able to provide opportunities for research and due to increased workloads, staff appeared to be stressed at work. A lack of remuneration and a change in career were the next most common reasons for staff turnover (5/9, 55.6%). Interestingly, only Taiwan and Singapore reported a loss of HTA staff in the private sector (Figure 9). When asked to nominate which was the most important limiting factor for the retention of HTA staff, responses were varied: • Shanghai, Malaysia - Stressful work environment due to high workloads and deadlines, and pressure for promotion • Taiwan and Indonesia - Lack of pay (leading to being headhunted by the private sector • Singapore, the Philippines, and South Korea – a lack of professional development ** ACE = Agency for Care Effectiveness 23

Background Paper Figure 9 Reported limitations to the retention of HTA agency staff When asked to identify the key competencies and skills missing from their agency, again, responses varied widely (Figure 10). Singapore reiterated that, on the whole, ACE had the right skill set balance but just not enough human resources to cope with increasing workloads. Cambodia reported deficiencies in all areas of HTA, closely followed by Vietnam. A lack of HTA staff leads to an increased workload and a stressed workforce. The most common “missing” skill sets reported were health economists and biostatisticians (5/9, 55.6%). Shanghai reported that in addition to administrative and staff qualified in healthcare policy, that medical informatics was a skill that they would like to recruit. Many staff involved in HTA often have undergraduate degrees in disciplines such as science or medicine and then use this skill set in addition to gaining post-graduate qualifications in an HTA-related field. All agencies except for Cambodia reported that their staff had post-graduate qualifications in an HTA-related field such as epidemiology or biostatistics. The most common background for agency staff was a qualification in medicine, statistics, or pharmacy (7/9, 77.8%), followed by biosciences (5/9, 55.6%). In addition to staff qualified in the range of fields, Malaysia reported staff qualified in hospital administration and as public health physicians. Breaking these figures down further, countries with large agencies such as South Korea (125 researchers), Singapore (80 technical and non-technical staff ) and Taiwan (40 FTE) reported high rates of HTA post- graduate qualifications in their full-time staff (ranging from 25%-80%). Demonstrating extremes of capacity, Shanghai reported that all faculty staff had a PhD qualification, whilst Cambodia had no staff, and the Philippines and Vietnam had low numbers (2 each) of staff with an HTA-related post-graduate qualification. Smaller agencies such as Indonesia also had a high proportion of post-graduates, reporting five of their 10 staff had appropriate qualifications. 24

Background Paper Figure 10 Key competencies missing from the respective HTA workforce When thinking about filling these gaps in competencies, overwhelmingly, agencies, with the exception of Vietnam, sought to recruit university graduates and to train them in HTA skills internally. Most agencies (66.7%) also seek to recruit domestically and internationally trained HTA personnel, as well as entry-level staff, with no degree to train in HTA internally. Only Cambodia could not offer any HTA training opportunities to their staff, with all other agencies offering internal training and mentoring (the Philippines only offered internal training). Most agencies offered access to post-graduate courses run by local universities, such as a Master of Public Health, evidence-based medicine and health economics. In addition, many of the agencies have embraced the use of on-line MOOCs. Only South Korea and Indonesia made use of training opportunities offered by industry active in the region (Figure 11). The Philippines, Cambodia, Shanghai and Indonesia thought that current access to training opportunities did not adequately address the demand for HTA in their country. 25

Background Paper Figure 11 HTA training opportunities offered to agency staff Networking and collaboration have been identified as key to facilitate the transfer of knowledge and skills, enable mentoring opportunities, in so doing, growing capacity. Agencies in the region clearly value networking, with HTAsiaLink and HTAi foremost among networking opportunities (8/9 agencies, 88.9%). ISPOR was also highly regarded for networking (66.7%), followed by INAHTA and local forums (55.6%). Summary of the results from the industry survey A total of ten industry participants responded to the survey; however, only nine answered in full. Of these, four are device manufacturers, five are pharmaceutical companies and one markets both pharmaceuticals and vaccines. All companies reported having an internal HTA capacity, mostly based in the Asia region (60%), with only one company reporting a more global focused HTA capacity, whilst three companies reported both a global and Asia regional based capacity. Many companies found it difficult to quantify the number of staff dedicated to HTA, mainly due to the global team structure of their company, and with staff having multiple functions within the company, supporting activities such as market access as well as HTA activities. Of the six companies that could quantify the number of staff dedicated to HTA activities, numbers ranged from 2-3 full-time equivalent in smaller companies, up to in excess of 30 employees in the larger global companies, many of whom would have a focus on particular countries in the region. Regardless of their undergraduate qualification (biosciences, medicine, pharmacy or statistics), all companies reported that all staff involved with HTA activities had an HTA-related post-graduate qualification, including public health, epidemiology, health economics and biostatistics. Companies in the region have invested in HTA, which may offer opportunities for increased collaboration between industry and agencies HTA training opportunities of some kind were offered by all companies, especially improving their HTA capacity by delivering internal training and mentoring as a minimum. The majority of companies (70%) supported their staff financially and with time off to access online HTA courses (MOOCs), as well as formal post-graduate HTA courses and short courses such as those run by ISPOR, demonstrating a commitment to build and invest in HTA. This commitment is also reflected by the majority of companies (70%) being involved 26

in the training and development of HTA skills in the region. How this training is delivered may offer future Background Paper opportunities for collaboration, as no companies reported having direct links with HTA agencies but rather conducted training in conjunction with local universities. This training covered the wide gamut of HTA skills, including general quantitative (safety, efficacy etc.), health economics (not just cost-effectiveness but also the articulation of value), biostatistics, as well as data (especially real-world data) collection and analysis. Interestingly, four companies were involved in providing HTA education for policy-makers, whilst others were interested in developing skills around fit-for-purpose registries (2/9) as well qualitative methodologies and patient assistance programs. As previously discussed, networking plays an important role in developing collaborations and developing skills. Overwhelmingly, industry respondents provide their staff access to HTAi (7/9), ISPOR (8/9) and local forums (7/9) to develop links with the HTA community. When asked to think about where the greatest gaps in HTA lie in the region, overwhelmingly respondents nominated access to data and policy-maker education (7/9, 77.8%) as the biggest issues, followed closely by basic HTA and health economic methodologies (Figure 12). Other issues nominated included having a more holistic approach to HTA such as partial multiple-criteria decision analysis and deliberative HTA. The applicability of evidence for decision-making was also raised, which ties in with the concern around understanding that there are alternatives to cost per QALY that may be more suitable to use in countries where there is limited access to data. Figure 12 Greatest gaps in HTA in the region as identified by industry respondents 27

Background Paper Following on from this question, respondents were asked to identify the most important elements that they perceive are currently lacking in HTA infrastructure in the Asia region (Figure 13). Interestingly, most respondents identified a lack of expertise in the implementation of HTA over the lack of funding and technical expertise to conduct HTA. Other issues raised included the misuse of HTA for cost-cutting purposes, indicating a lack of policy-maker education. Tying in with this comment is the difficulties that decision makers have in understanding costs per QALY, especially coming up with a measure that can be inclusive of all stakeholders, especially patients. Human resource capacity was also identified as a problem, with the lack of HTA personnel resulting in a lack of capacity to produce product reviews in a timely manner. Figure 13 The main factors that were identified as lacking 28

Background Paper Talking Points - HTA capacity appraisal. building in the Asia region • Variation in HTA expertise country by country. The final question in the pre-meeting surveys was to ask respondents to identify the greatest • To connect with HTA organizations challenge and success of their agency or company in terms of HTA capacity building in the region. • How HTA systems can accurately define and These answers provide another springboard for fairly assess outcomes delivered by health discussions during the 2022 APF, especially in innovations relation to understanding and implementing a capacity building roadmap. • Sound methodological approach by HTA agencies Agency challenges • Lack of data/access to data. Uncertainty in the • Getting funding and study leave approval for evidence base. Lack of health care spending post graduate training. • How to lead primary HTA development in a • Capacity building on new methodologies global setting • Lack of funding, Human Resources, capacity and • More dialogue with payers about HTA is needed competencies, and power of institution to ensure the right evidence is generated/ developed • Staff commitment and support from policy- makers • For many markets, neither the government/ payer stakeholders nor the internal industry • Sufficient funding, staffing and organizational talent have exposure to more developed HTA development markets to understand what 'good' looks like, nor the training to do the work to the higher • Lack of human resources standard Agency successes Industry successes • Collaboration with local universities and experts • A unified company approach/position to HTA to to build capacity support all countries in all regions • Building cooperation between different • Agencies being more willing to discuss and stakeholders. engage with industry. More collaboration is needed to address uncertainties from both Industry challenges stakeholders. • Lack of education around why certain HTA • Building internal capabilities in the region approaches may be more appropriate than others, how this impacts results and an • A strong presence and engagement in key HTA unwillingness to discuss these challenges. organizations and platforms around the world • Opportunities to deliver training • Increased understanding of clinical and economic evidence across the company using • The broad adoption of more holistic HTA an internal training program processes and approaches e.g. deliberative HTA and partial MCDA, with multiple stakeholders • and multi-criteria for both assessment and 29

Background Paper Appendix 1 Pre-meeting surveys Who does your agency • Department of conduct HTA for? Check Health In the past, health technology assessment (HTA) all that apply has been one of the main priority-setting tools • Other government used by health policy-makers to inform evidence- What type of departments based decision-making on the quality, safety and technologies do you cost-effectiveness of new healthcare technologies. assess? Check all that • Regulators As discussed in previous Asia Policy Forums, HTA apply • Non-government capacity building in the Asia region has continued to be an issue, especially the training, recruitment, What are the organizationas (e.g. and retention of skilled HTA practitioners as limitations of the HTA WHO) countries continue to move toward Universal Health infrastructure in your • I ndustry/private Care. country? Check all that sector apply • I nternational These surveys were intended to identify some of the agencies (e.g. NICE issues and challenges around HTA capacity in the As of the beginning International) region to inform discussions at the 2022 APF annual of 2022, how many • Other (please specify) meeting. staff did your agency • Drugs employ? Can you break • Medical devices Not-for-profit agencies survey questions this down to full-time • D iagnostic tests and part-time workers? • Vaccines Which country does • Yes Do you think that this • Surgical procedures your agency represent? • N o staffing level is • Health screening Is your agency On average, how long programs embedded within the • Yes do staff stay in your • P ublic health Department of Health? • No agency? programs Is your agency • Other (please specify) embedded within or • Yes • Lack of technical have strong links with a • No expertise to conduct university? HTA Is your agency an • Department of • L ack of HTA training independent (private Health • L ack of expertise in sector) agency? implementation of Who funds your HTA • O ther government HTA activities? Check all that departments • L ack of funding for apply HTA development • R egulators • L ack of political • N on-government support for using HTA in policy organizations (e.g. • O ther (please specify) WHO) • Industry/private • Below capacity sector • J ust right • International • A bove capacity agencies (e.g. NICE • < 1 year International) • 1-3 years • Other (please specify) • > 3 years 30

What are the limitations • Lack of pay Of the staff who have • Qualified HTA Background Paper in respect to retaining • Lack of opportunities an undergraduate personnel – HTA staff? Check all that qualification, domestically trained apply for promotion how many have a • Lack of professional HTA-related post- • Q ualified HTA Of the limitations graduate qualification personnel – above, which factor do development (epidemiology, Internationally you think is the most • S taff head hunted biostatistics etc)? trained important? Does your agency seek If below capacity, by private sector/ to recruit…… Check all • U niversity graduates what key skills are you industry that apply and train HTA skills missing? Check all that • C hange of career internally apply • L ack of research What HTA training opportunities opportunities are • Entry level staff (no Thinking only of • L ack of recognition available in your degree) and train HTA your staff involved in • S tressful work agency? Check all that skills internally conducting HTA, what environment apply qualifications do they • O ther (please specify) • Internal training and have? Check all that Do these training mentoring apply • Administration staff opportunities • HTA specialist – adequately cater to the • F ormal post-graduate HTA demand in your HTA courses run by pharmaceuticals country? local universities • HTA specialist - What networking opportunities do staff • Online HTA courses devices at your agency get to (MOOCs) run • HTA specialist – undertake to develop by international links with the HTA universities diagnostics community? Check all • HTA specialist - that apply • Links with industry Finally, what do you active in the region epidemiologist see as your agency’s • HTA specialist – greatest challenge and • N one its greatest success in • O ther (please specify) evidence-based terms of HTA capacity • Yes medicine building? • N o • HTA specialist – qualitative • H TAsiaLink • Health economist • H TAi • Biostatistician • I SPOR • Healthcare policy • INAHTA • Regulatory expert • Local forums • Other (please specify) • Other • Biosciences • M edicine • P sychology • S tatistics • P harmacy • P ost-graduate in HTA-related field (epidemiology, biostatistics etc) • Other (please specify) 31

Background Paper Industry survey questions Which company do you • Drugs What HTA training • Internal training and represent? • Medical devices opportunities are mentoring What type of health • Diagnostic tests available in your technology is your • V accines company? Check all • Formal post-graduate company’s primary • O ther (please specify) that apply HTA courses product? • Yes (go to Q5) Does your company • No (go to Q4) Is your company • Access to online HTA have an internal HTA actively involved courses (MOOCs) capacity? • Department of in the training and If no, does your Health-based HTA development of HTA • N one company have active agencies skills in the region? • O ther (please specify) HTA engagement If yes, is this training • Yes (go to Q11) with…. • U niversity-based HTA conducted…. • No (go to Q13) agencies (Asia region) If yes, where is this Does this training • Directly with HTA capacity based? • U niversity-based HTA consist of developing agencies If yes, how many staff agencies (non-Asia skills in….( Check all does your company region) that apply) • I n conjunction with have dedicated to HTA? local Universities Can you break this • Private provider HTA down to full-time and agencies (Asia region) • O ther (please specify) part-time workers? • General HTA Thinking only of • Private provider HTA your staff involved in agencies (non-Asia (quantitative conducting HTA, what region) assessment: safety, qualifications do they efficacy etc) have? Check all that • Other (please specify) • Health economics apply • None methodologies • In the Asia region • B iostatistics Of the staff who have • O utside of the Asia methodologies an undergraduate • Data collection qualification, region • Data analysis how many have a • D eveloping fit-for- HTA-related post- • Biosciences purpose registries graduate qualification • Medicine • Qualitative (epidemiology, • Psychology methodologies biostatistics etc)? • Statistics • Patient assistance • Pharmacy programs • Post-graduate in • P roviding ‘education’ for policy-makers HTA-related field • O ther (please specify) (epidemiology, biostatistics etc) • Other (please specify) 32

In your experience, • Basic HTA Background Paper what are the greatest methodology gaps in HTA in the (quantitative region? Click all that assessment: safety, apply efficacy etc) What are the • Health economics limitations of the HTA methodologies infrastructure in the Asia region? Check all • Biostatistics that apply methodologies What networking opportunities do staff • P olicy-maker in your company get to education (policy undertake to develop development from links with the HTA evidence) community? Check all that apply • Clinician education Finally, what do you • P ublic/patient see as your company’s greatest challenge and education its greatest success in • Regulator education terms of HTA capacity • Access to data building in the region? • O ther (please specify) • Lack of technical expertise to conduct HTA • L ack of HTA training • Lack of expertise in implementation of HTA • Lack of funding for HTA development • L ack of political support for using HTA in policy • O ther (please specify) • HTAsiaLink • HTAi • ISPOR • INAHTA • Local forums • Other (please specify) 33

Background Paper Appendix 2 – Catalogue of HTA-specific capacity building initiatives Asia-Pacific Economic Co-operation (APEC) APEC's wide-ranging economic work program makes it uniquely positioned to address the multi-sectoral impact of today's health threats. In October 2003, APEC established the Health Task Force (HTF) to help address health-related threats to economies' trade and security, focusing mainly on emerging infectious diseases, including naturally occurring and man-made diseases. In 2007, after a review of the APEC fora, the HTF was upgraded in status to become the Health Working Group (HWG). In addition to engaging with other APEC fora and international organizations like the World Health Organization, the World Bank and the Association of South-East Asian Nations, the HWG has positioned itself as a regional health forum dedicated to demonstrating the value of health to economic growth and development and to building awareness of the return on investment on health innovation. The mandate of the HWG is to work with partners to improve people’s health and well-being, aiming to promote trade, security, inclusive growth and development in the APEC region. The goal of the HWG is to help reduce the impact of health-related threats to the economy, trade and security of member economies. The HWG aims to strengthen health systems to increase their efficiency, responsiveness and resilience to achieve and maintain universal health coverage. Some of the HWG’s objectives include: • To strengthen health systems to improve accessibility, sustainability and quality of healthcare; and • To encourage and facilitate collaboration between health and other sectors, other APEC fora and international health bodies. Some industry members of the APF may be involved in this initiative. Contacts: Dr Pongsadhorn POKPERMDEE HWG Chair (2022-2023) Senior Advisor to Ministry of Public Health, Thailand Email: [email protected] Assisted by Dr. Ratchakorn KAEWPRAMKUSOL Email: [email protected] Michael PEARSON (Mr) HWG Vice Chair (2022) Branch Head, Office of International Affairs for the Health Portfolio Government of Canada Email: [email protected]; [email protected] Aurora TSAI (Ms) Program Director Email: [email protected] 34

Background Paper https://www.apec.org/groups/som-steering-committee-on-economic-and-technical-cooperation/ working-groups/health i-HTS learning platform by EuroScan New platform to support capacity building in Early Awareness and HTA. This learning platform and sources should help ease your way to run a sophisticated EAA / HTA unit:- • support staff members to run projects, use digital tools in daily affairs and in network situations; • to understand Early Awareness, Appropriate Usage and Disinvestment methodologies related to health technologies and services including filtration and prioritization; and • to prepare and use HTA methods and tools in decision processes. https://ihts.talentlms.com/ - write to [email protected] to get registered. Between 2016 and 2019 a survey was conducted to identify accessible HTA capacity building materials. Firstly, a literature review was conducted to identify published and accessible handbooks and toolkits. This was followed by a survey of universities and HTA professionals specifically aimed to: (1) understand and list current competencies offered at universities and/or HTA institutions (i.e., HTA agencies, patient organizations, or organizations offering different HTA courses); (2) identify existing educational and training programs for HTA around the world; and (3) create a common understanding of the various competencies which could be embedded in (future) HTA educational and training programs.28 In addition, APF members were asked to add the details of any accessible HTA courses that they know of (i.e. courses that anyone in the world can enroll and participate in, that would result in a recognizable qualification). 35

Background Paper Courses and resources relevant to the Asia region MaHTAS (Malaysian HTA section) Provides courses on HTA, EBM, epidemiology, literature searching, systematic literature reviews, health economics and statistics to newly employed staff, Expert Committee members, Technical Advisory Committee, policy-makers, clinicians and other health care professionals. Some of these courses are conducted in collaboration with universities. MaHTAS also organizes seminars and workshop on topics related to HTA. University of Malaya, Kuala Lumpur offers: • 1-year full time Master of Epidemiology with a minimum of 42 credits • Master of Public Health - https://spm.um.edu.my/academic/mph/ • The minimum duration of study shall be two (2) regular semesters and one (1) special semester (maximum duration of study shall be eight (8) semesters). • Short courses on topics related to Evidence-based Medicine. CDE, Taiwan HTA, EBM, Literature searching, Systematic literature reviews, Health economics, Statistics, ELSO issues, Utility and outcome measures Offered frequently Seminars (once a month), Workshops, Intensive courses, Online, Collaborating with Universities Offered to newly employed staff and current staff, patient and citizen organizations. Current CDE staff can access a MOOC covering a range of topics, including an introduction to epidemiology and statistics. In addition, masters and doctoral students can attend a challenge camp with the Taiwan Society for Pharmacoeconomics and Outcome Research to cultivate HTA strengths and understanding. Offered payment training courses for manufacturers To respond to the increasing demand for HTA proficiency and with the sponsorship of the CDE, Taiwan, the Health Technology Assessment Credit-Certificate Program was established at Taipei Medical University (TMU) in 2017. The program integrated university HTA-related courses to cultivate HTA proficiency and promote HTA-related research. All registered TMU undergraduate and graduate students were eligible to apply for the HTA program, and applicants could obtain a certificate upon successful completion of 16 required credit units or about 8 courses. The required credits include 4 credits for the Basic Module, 6 credits for the Core Module, and 6 credits for the Application Module. The Basic Module consists of two mandatory courses: biostatistics and epidemiology. The Core Module has three subject areas, and students need to obtain two credits in each area: (1) health economics/pharmacoeconomics, (2) evidence-based medicine, and (3) pharmacy administration/health care policy. In the Application Module, students were able to choose from a list of more than ten courses. Reference: Wu YS, Chen C, Wang LC, Jian LS, Ko Y. Talent cultivation in health technology assessment: an expert survey. BMC Med Educ. 2022 Mar 8;22(1):157 Fudan University, Shanghai, China HTA courses offered under the Master of Science (MS), Master of Public Health (MPH) and PhD programs at School of Public Health. Fudan delivers HTA courses and pharmacoeconomics courses for under- and post- graduate programs. The other related courses include epidemiology (different levels), statistics (different levels), EBM, literature review, health economics (different levels), research design, health service research, program evaluation, health care management, hospital management, social medicines, etc. All graduate 36

programs require a thesis. Background Paper Fudan produced the first Massive Open Online Course (MOOC, 12 modules) in HTA in Chinese (with English subtitle), and delivers a national continuous education program of HTA, in-person training workshop (5-day Module, 40 teaching hours), 1-2 times per year. (50-100 participants from HTA agencies, universities, hospitals, CDC, government or industrials). HTA post-graduate courses MSc HTA courses†† (offered in 2016/2017)28 • MSc in International Health Technology Assessment, Pricing and Reimbursement: 3 modules over 2 years University of Sheffield, UK. http://www.sheffield.ac.uk/scharr/prospective_students/masters/ihtapr • MSc in HTA: 12 months full-time; 24 months part-time University of Glasgow, UK http://www.gla.ac.uk/postgraduate/taught/healthtechnologyassessment/ • Public Health (Health Technology Assessment) MPH/PG Diploma/PG Certificate: 1 year FT, 2 years PT University of Birmingham, UK, http://www.birmingham.ac.uk/postgraduate/courses/taught/med/public- health-tech-assessment.aspx • MSc in HTA, at least 1 year after BSc, 5 modules University Medical Center Radboud Nijmegen, The Netherlands, https://www.radboudumc.nl/en/ research/departments/health-evidence/education • MSc in HTA, minimum of 2-years, maximum time permitted or completion of the program is 4-years University of Alberta, Canada, http://uofa.ualberta.ca/public-health/programs/msc-programs/msc-health- technology-assessment • Master of Science Program in Health Technology Assessment, Evidence-Based Healthcare and Decision Science, modules, thesis and internship UMIT, Austria, https://calendar.ualberta.ca/preview_program.php?catoid=28&poid=26992 • Evaluation methods: Online module within Masters/Graduate Diploma in Public Health University of Sydney, Australia https://www.sydney.edu.au/medicine-health/study-medicine-and-health/professional-development-and- short-courses/public-health/foundations-of-health-technology-management.html • HTA: Online module within Masters/Graduate Diploma in Public Health University of Adelaide/ AHTA, Australia https://health.adelaide.edu.au/public-health/short-courses/health-technology-assessment • HTA: Masters program and Short courses Instituto Nacional de Cardiologia, Brazil https://www.mestradoinc.com.br/en/mestrado-em-avaliacao-de-tecnologias-em-saude/ • HTA: Graduate course within Epidemiology program/ Health Systems University of Ottawa, Canada https://catalogue.uottawa.ca/en/graduate/master-science-epidemiology-specialization-biostatistics/ • HTA McMaster University, Canada https://academiccalendars.romcmaster.ca/preview_program. php?catoid=25&poid=14636&hl=%22health+technology+assessment%22&returnto=search • Health economics: Masters in Global Health economics John Hopkins University, USA https://publichealth.jhu.edu/academics/mhs-in-global-health-economics • Health economics: Doctoral program in Healthcare economics †† These courses were offered/surveyed in 2016/2017. Some may not be offered moving forward into 2023) 37

Background Paper Brown University, USA https://www.brown.edu/academics/public-health/hspp/doctoral-program • HTA: blended online, module within Masters of Public Health University of Pretoria, South Africa https://www.up.ac.za/yearbooks/2021/pdf/programme/10256502 • HTA: Masters/ short course UiT Artic University, Norway https://en.uit.no/education/courses/course?p_document_id=743840 • Introduction to Health Economic Evaluation: 1-day short course University of Oxford, UK https://www.herc.ox.ac.uk/herc-short-courses/introduction-to-health-economic-evaluation • Applied Methods of Cost-Effectiveness Analysis: 3-day short course University of Oxford, UK https://www.herc.ox.ac.uk/herc-short-courses/applied-methods-of-cost-effectiveness-analysis • Introduction to systematic reviews and Health Economics: 1-day short course University of Southampton, UK https://www.southampton.ac.uk/shtac/training/systematic-reviews-training.page • Systematic assessment of medical technologies: Blended online 6-month module in Masters Technical University of Berlin, Germany • HTA: Blended online module (undergraduate, post-graduate, PhD training, short courses) Institute of Medical Technology Assessment, (iMTA), Netherlands • HTA: 2-day short course UMC Utrecht Julius Center 38

Possibly not running any more: Background Paper • Ulysses Program: 8 courses divided in 4 modules, over 2 years Four Universities (Montreal, Barcelona, Rome and Toronto), http://docplayer.net/3075169-Ulysses- program-the-3rd-edition-2005-2007-international-master-s-program-in-health-technology-assessment- and-management-hta-m-what-is-hta.html • Health technology assessment - HTA La valutazione delle tecnologie in sanità, 60 credits: estimated 380 hrs + 500 hrs Master thesis Universita degli Studi di Padova, Italy, http://www.unipd.it/health-technology-assessment-hta-la- valutazione-delle-tecnologie-sanita • HTA Module: 90hours Kazakh Medical University, Kazakhstan • Refresher course in HTA: MOOC and modules within Master of Public Policies Fundação Oswaldo Cruz (FioCruz), Brazil • HTA project: Within Masters or post graduate programs in Biostatistics, Epidemiology and Informatics University of Pennsylvania, USA • Module on quantitative HTA methods: Blended online within Masters of Public Health in Health Policy and Management Center for the Evaluation of Value and Risk in Health, Tufts Medical Centre, USA • Economic Evaluation module: within Masters of Public Health and Post-graduate Diploma in Heath Economics University of Cape Town, South Africa • Economic Evaluation module: within Masters of Public Health University of Witwatersrand School Of Public Health, South Africa • HTA Advanced course: within Economic Evaluation of Healthcare programs - Masters in International Management Economics & Policy SDA Bocconi, Italy Handbooks and Toolkits • EUnetHTA, Europe EUnetHTA Handbook on HTA Capacity Building (2008) Available from: https://www.eunethta.eu/eunethta-handbook-on-hta-capacity-building/ • EUnetHTA, Europe HTA core model Available from: https://www.eunethta.eu/hta-core-model/ • DACEHTA, Denmark Health Technology Assessment Handbook (2007) Available from: https://www.sst.dk/~/media/ECAAC5AA1D6943BEAC96907E03023E22.ashx • KCE, Belgium Search for Evidence & Critical Appraisal: Health Technology Assessment (HTA) (2007) Available from: https://kce.fgov.be/sites/default/files/2021-11/kce_process_notes_hta_1.pdf • Lewin Group, USA Introduction to health technology assessment (2014) Available from: https://www.nlm.nih.gov/nichsr/hta101/HTA_101_FINAL_7-23-14.pdf • AGENAS, Italy Manuale delle procedure HTA (2015) Available from: https://www.agenas.gov.it/ricerca-e-sviluppo/649-manuale-procedure-hta-articoli- approfondimenti • Institute for Quality and Efficiency in Health Care (IQWiG) General Methods Available from: https://www.iqwig.de/methoden/general-methods_version-6-1.pdf • The VALIDATE Handbook An approach on the integration of values in doing assessments of health technologies Available from: https://validatehta.eu/downloads/ • EuroScan International Network A toolkit for the identification and assessment of new and emerging health technologies (2014). Available from: http://epapers.bham.ac.uk/2120/1/EuroScan_Methods_Toolkit_October_2014_FINAL_CC_ added.pdf 39

Background Paper References 1. Wu, Y. S., Chen, C. et al (2022). 'Talent cultivation in health technology assessment: an expert survey'. BMC Med Educ, 22 (1), 157. 2. Sharma, M., Teerawattananon, Y. et al (2021). 'A landscape analysis of health technology assessment capacity in the Association of South-East Asian Nations region'. Health Res Policy Syst, 19 (1), 19. 3. Tantivess, S., Chalkidou, K. et al (2017). 'Health Technology Assessment capacity development in low- and middle-income countries: Experiences from the international units of HITAP and NICE'. F1000Res, 6, 2119. 4. Mueller, D., Gutiérrez-Ibarluzea, I. et al (2016). 'Capacity Building in Agencies for Efficient and Effective Health Technology Assessment'. Int J Technol Assess Health Care, 32 (4), 292-9. 5. Mundy, L., Kearney, B. J.& Trowman, R. Universal Health Care in the Asia Region: Overcoming the Barriers using HTA and Real World Data. HTAi Asia Policy Forum Background Paper [serial on the Internet]. 2017 [cited 2022 14th June]: Available from: https://htai.org/wp-content/uploads/2018/07/HTAi-2017-Asia- Policy-Forum-Background-Paper.pdf. 6. Mundy, L., Kearney, B. J.& Trowman, R. Improving access to high-cost technologies in the Asia region. HTAi Asia Policy Forum Background Paper [serial on the Internet]. 2018 [cited 2022 14th June]: Available from: https://htai.org/wp-content/uploads/2019/06/HTAi_asia-policy-forum_2018-background-paper_final.pdf. 7. Mundy, L.& Kearney, B. J. HTA in Asia Post-COVID. HTAi Asia Policy Forum Background Paper [serial on the Internet]. 2021 [cited 2022 14th June]: Available from: https://htai.org/wp-content/ uploads/2021/12/2021-APF.pdf. 8. ISPOR (2021). HTA’s Evolving Role through the COVID Pandemic and Beyond – Virtual ISPOR 52nd HTA Roundtable – Latin America. [Internet]. ISPOR - the Professional Society for Health Economics and Outcomes Research. Available from: https://press.ispor.org/LatinAmerica/2021/02/htas-evolving-role- through-the-covid-pandemic-and-beyond-virtual-ispor-52nd-hta-roundtable-latin-america/ [Accessed 30th September 2021]. 9. Teerawattananon, Y., Tantivess, S. et al (2009). 'Historical development of health technology assessment in Thailand'. Int J Technol Assess Health Care, 25 Suppl 1, 241-52. 10. Liu, G., Wu, E. Q. et al (2020). 'The Development of Health Technology Assessment in Asia: Current Status and Future Trends'. Value Health Reg Issues, 21, 39-44. 11. Chootipongchaivat, S., Tritasavit, N. et al (2015). Factors conducive to the development of health technology assessment in Asia: Impacts and policy options, World Health Organization, Geneva, Switzerland http:// www.idsihealth.org/wp-content/uploads/2016/02/CONDUCIVE-FACTORS-TO-THE-DEVELOPMENT_resize. pdf. 12. Bester, A. (2015). Capacity development, United Nations Department of Economic and Social Affairs https://www.un.org/en/ecosoc/qcpr/pdf/sgr2016-deskreview-capdev.pdf. 13. Zamfir, I. (2017). Understanding capacity-building/capacity development. A core concept of development policy, European Parliament https://www.europarl.europa.eu/RegData/etudes/BRIE/2017/599411/EPRS_ BRI(2017)599411_EN.pdf. 14. United Nations Academic Impact: Capacity building. [Internet]. United Nations. Available from: https:// www.un.org/en/academic-impact/capacity-building#:~:text=Capacity%2Dbuilding%20is%20defined%20 as,in%20a%20fast%2Dchanging%20world. [Accessed 15th June 2022]. 15. United Nations (2018). Capacity development, United Nations Development Group https://unsdg.un.org/ sites/default/files/UNDG-UNDAF-Companion-Pieces-8-Capacity-Development.pdf. 16. Kenny, S.& Clarke, M. (2010). Challenging capacity building: Comparative perspectives, Vol. Springer. 17. Li, R., Ruiz, F. et al (2017). 'Evidence-informed capacity building for setting health priorities in low- and middle-income countries: A framework and recommendations for further research'. F1000Res, 6, 231. 18. John, D. (2019). 'HTA flourishing in Asia'. Int J Technol Assess Health Care, 35 (6), 411-2. 40

19. Teerawattananon, Y., Luz, K. et al (2018). 'HISTORICAL DEVELOPMENT OF THE HTAsiaLINK NETWORK AND Background Paper ITS KEY DETERMINANTS OF SUCCESS'. Int J Technol Assess Health Care, 34 (3), 260-6. 20. Teerawattananon, Y., Rattanavipapong, W. et al (2019). 'Landscape analysis of health technology assessment (HTA): systems and practices in Asia'. Int J Technol Assess Health Care, 35 (6), 416-21. 21. Tropical Agriculture Platform (2016). Common Framework on Capacity Development for Agricultural Innovation Systems, CAB International, Wallingford, UK https://www.cabi.org/Uploads/CABI/about- us/4.8.5-other-business-policies-and-strategies/tap-synthesis-document.pdf. 22. Pichler, F., Oortwijn, W. et al (2019). 'Defining capacity building in the context of HTA: a proposal by the HTAi Scientific Development and Capacity Building Committee'. Int J Technol Assess Health Care, 35 (5), 362-6. 23. ADB (2011). Practical Guide to Capacity Development in a Sector Context, Asian Development Bank https:// www.adb.org/sites/default/files/institutional-document/33285/files/cd-guide-sector-context.pdf. 24. Gordijn, F. (2006). The ‘What is’ and ‘How to’ of Capacity Development. Available from: http://www.bibalex. org/search4dev/files/314804/145405.pdf [Accessed 20th August 2022]. 25. Uzochukwu, B. S. C., Okeke, C. et al (2020). 'Health technology assessment and priority setting for universal health coverage: a qualitative study of stakeholders' capacity, needs, policy areas of demand and perspectives in Nigeria'. Global Health, 16 (1), 58. 26. Hollingworth, S. A., Ruiz, F. et al (2020). 'Health technology assessment capacity at national level in sub- Saharan Africa: an initial survey of stakeholders'. F1000Res, 9, 364. 27. WHO (2021). Health Technology Assessment Survey 2020/21. Available from: https://www.who.int/data/ stories/health-technology-assessment-a-visual-summary [Accessed 7th September 2022]. 28. Mueller, D., Gutierrez-Ibarluzea, I. et al (2020). 'Toward a common understanding of competencies for health technology assessment: enhancing educational and training programs around the globe'. Int J Technol Assess Health Care, 37, e29. 41

Attendees Rob Abbott Executive Director HTAi Canada [email protected] Rob Abbott is a pioneering strategy and social responsibility catalyst in Canada; a much sought-after facilitator, moderator and content-weaver; a coach to entrepreneurs and executives; and a professor of global management and strategy. Rob’s experience in medical life sciences includes appointments as a member of the Board and Executive Committee of the Canadian Genetic Diseases Network (CGDN), and the Canadian Gene Cure Foundation. He subsequently became CEO of CGDN, a role that required him to regularly discuss advances in gene-based medical research on the one hand, and the translation of that research into practical diagnostics and therapeutics on the other. He has also advised provincial and federal health authorities in Canada and abroad on a wide variety of issues, including the role of artificial intelligence and advanced robotics in the delivery of health care. Rob writes and speaks on strategic environmental issues regularly, and is the author of Uncommon Cents: Thoreau and the Nature of Business; Conscious Endeavors: Business, Society and the Journey to Sustainability; and co-author of the forthcoming book, The Future of Mining: 7 Steps to a Globally Sustainable Industry. Rob is also working on a book, called Walking Toward the Edge: From Heartbreak to Hope in an Age of Loss. Rob has taught courses and delivered lectures at several universities in North America including the University of Toronto, the University of British Columbia, and Harvard. He has also taught at universities in China, Thailand, and Mexico. Ryouko Araya Market Access Takeda Pharmaceutical Company Limited Japan [email protected] I belong to the Market access department. I am in charge of drug pricing. I am also a member of a pharmaceutical industry association. Previously I was on the Regional Access team. My career started with Medical Rep. 42

Alex Best Attendees Market Access Policy Janssen Singapore [email protected] @AlexBest1985 www.linkedin.com/in/alex-best-245168111/ Over 15 years’ experience working in the Australian healthcare landscape across pharmaceutical and medical device policy, including as an adviser to the Australian Minister for Health. Thomas Butt Senior Director Health Economics & Outcomes Research Biomarin United Kingdom [email protected] Dr Thomas Butt is Senior Director, Health Economics & Outcomes Research at BioMarin. He is responsible for the global health economics function, developing evidence to demonstrate the value of BioMarin's pipeline and marketed rare disease portfolio. His research interests are in methods of value assessment and he has published 20+ peer reviewed articles in the field. Thomas holds a PhD degree in health economics from University College London (UCL) in the United Kingdom and conducted postdoctoral research at Peking University in Beijing, China. Sarah Chan Senior Manager Edwards Lifesciences Singapore [email protected] Sarah Chan is Senior Manager with the Japan, Asia and Pacific Market Access team at Edwards Lifesciences. She is a licensed pharmacist based in Singapore with post-graduate training in business administration and public health. She has experience in HTA, health economics and outcomes research and healthcare consulting across public and commercial sectors. 43

Attendees Yingyao Chen Director NHC Key Lab Of Hta, Fudan University China [email protected] Yingyao Chen is Professor of Health Services at the School of Public Health, Fudan University (FUSPH), Director of the Key Lab of Health Technology Assessment (National Health Commission) at Fudan University, and Director of WHO Collaborating Center for Health Technology Assessment and Management. As well, he is the Associate Dean of the School of Public Health, responsible for international collaborations. He received his Bachelor of Medicine at Shanghai Medical University in 1991, his Master of Public Health at Shanghai Medical University in 1997, and earned his Ph.D. in Management at Fudan University in 2006. He took part in a visiting scholar program at the University of California, Los Angeles, 1999-2001. His academic interests focus on health technology assessment, health policy, health economics, and hospital management. He was a PI of several projects funded by the World Health Organization, World Bank, China Medical Board, Ministry of Health, Ministry of Science and Technology, National Natural Science Foundation of China, and provincial health authorities. He serves as one of board of directors of Health Technology Assessment international (HTAi) (2016-2019), WHO Expert Members for Guideline on Country Pharmaceutical Pricing Policies, WHO TAG on Health Benefit Packages, etc. John Cheong Health System Partner Roche Singapore [email protected] Health System Partner for Roche Singapore, responsible for ecosystem partnership and access policy engagements. Member of the Government Affairs and HTA working group for Singapore Association of Pharmaceutical Industries (SAPI). 44

Lesley Chim Attendees Senior Director, Market Access, APAC Biomarin Hong Kong [email protected] Dr. Lesley Chim is Senior Director of Market Access, APAC, at BioMarin Pharmaceutical Inc. Lesley has a background in pharmacy and over 20 years of industry experience. Prior to joining the pharmaceutical industry, she worked as a pharmacist in both community and hospital pharmacy. Lesley started her career in thecpharmaceutical industry as a regulatory affairs associate and worked in a variety of roles including clinicalcresearch and medical information before making a full transition into health economics. She holds a Bachelor of Pharmacy, a Master of Public Health (Hons), a Doctor of Philosophy (Medicine) from the University of Sydney, Australia, and a Master of Commerce from the University of New South Wales, Australia. Shuyu Chio Director, Policy & Public Affairs Pfizer Singapore [email protected] www.linkedin.com/in/shuyu-chio-6b3378209/ Shuyu is the Director of Policy and Public Affairs in Pfizer Emerging Asia. Based in Singapore, she is responsible for driving corporate engagement strategies to shape public affairs and policy initiatives in Singapore, Hong Kong and Taiwan. Prior to joining Pfizer, Shuyu has held appointments in public and private sectors where she spearheaded various initiatives to advance strategic partnerships, media relations and reputation management. She brings with her over 15 years of public affairs experience from industries including healthcare, tourism, and logistics. Songhee Cho Team Head National Evidence-based healthcare Collaborating Agency South Korea [email protected] Dr. Songhee Cho has worked in the field of health technology assessment and outcomes research using real-world data. She is currently a Head of Research Planning and Development Team in the Patient Centered Clinical Research Coordinating Center. 45

Attendees Ji Eun Choi Senior Research Fellow National Evidence-based Healthcare Collaborating Agency South Korea [email protected] I am a senior research fellow and the Director of Division of Health Technology Assessment Research of NECA. I have worked for NECA for more than 10 years from the establishment of the agency and experienced in Department of Health Care Safety, Department of Research Planning and Department of New Health Technology Assessment. Saudamini V Dabak Head, International Unit Health Intervention and Technology Assessment Program (HITAP) Thailand [email protected] Saudamini Dabak is the Head of HITAP’s International Unit (HIU). She started working at HITAP as an Overseas Development Institute (ODI) Fellow in 2015. At HITAP, Saudamini has supported Health Technology Assessment (HTA) initiatives in Asia and Africa and has also been involved in conducting health systems research. Prior to working at HITAP, Saudamini worked at the World Bank Group. She completed her Master of Arts from the Johns Hopkins School of Advanced International Studies (SAIS), USA, and holds a Bachelor of Arts in Economics from St. Xavier’s College, University of Mumbai, India. Ben Forrest Director Intuitive United States [email protected] Ben has worked in healthcare economics and investment research for over 20 years. He currently serves as the Global Director for Access and Value Development at Intuitive. In this role he works with internal and external stakeholders to assess and communicate the value of Intuitive technologies. Ben previously served as the Director of Health Economics for an early stage company, HeartFlow, where he took the organization through initial health technology assessments and reimbursement. Prior to HeartFlow, Ben worked as an Investment Analyst at Summer Street Research and Citigroup where he focused on emerging medical technologies. Ben received Bachelors degrees in Economics and International Studies from Brigham Young University, a Masters degree in Business Administration from Stanford University, and a Masters degree in Economics for Health Technology Assessment from the University of York. Ben loves to bike run, and hike and is constantly trying to keep up with his three kids. 46

Grace Li Ying Huang Attendees Director CDE, Taiwan Taiwan [email protected] Dr. Li Ying (Grace) Huang is a director of the Division of the Health Technology Assessment, Center for Drug Evaluation, Taiwan (CDE/HTA). Before joining CDE/HTA in 2008, she worked for around ten years as a clinical pharmacist in a leadership role in the department of pharmacy in one of the major medical centers in Taipei. She completed her Ph.D. degree in Graduate Institute of Health Policy and Management, College of Public Health, National Taiwan University and Master’s degree in pharmaceutical science from the National Taiwan University as well. She has authored and co-authored articles published in several international journals and also serves as a reviewer of manuscripts. Her current research focuses on comparative efficacy of new drugs, applying mixed treatment comparison methods, patient involved HTA and therapeutic inertia among adult DM patients in Taiwan. In 2020, Dr. Li Ying (Grace) Huang currently serves on the board of Directors for the Board of Directors for the HTAi. Grace has been a member of the INAHTA Board for the following terms: Director 2016-2018 and 2019- 2021. Miho Inukai HEVA Sanofi [email protected] HEOR/HTA analyst Hong Ju Senior Principal Lead Specialist Agency for Care Effectiveness, MOH Singapore [email protected] Experienced clinician-trained epidemiologist with a demonstrated track record of working in various settings to assist policy decision-making. Skilled in health technology assessment, epidemiology, evidence-based medicine, data analysis, etc. with high ethical and professional conduct. 47

Attendees Rabia Kahveci Senior Technical Advisor & HTAi Vice-President Management Sciences for Health Ukraine [email protected] Ms. Kahveci has 20 years of professional life, 15 of which dedicated to improving evidence based clinical practice and policy making, quality of health care, health policy support, systems strengthening and systems thinking. Majority of her work included integration of priority setting strategies –including health technology assessment- to health reform activities in low and middle income countries, as well as driving policies for pricing and reimbursement of health technologies. She has broad experience in all health care decision-making levels including primary care, hospital care, hospital management and policy-making at the national level. Dr Kahveci is known for her active work in NGOs and is Vice President of International Health Technology Assessment Society and President Elect for the same society as of 2023. She currently serves as Senior Technical Advisor, Pharmaceutical Policy and Governance, at the USAID funded SAFEMed Project, led by Management Sciences for Health, and based in Kiev, Ukraine. Masafumi Kato Market Access, Public Affairs And Patient Experience, Japan Pharma Business Unit Takeda Pharmaceutical Company Limited Japan [email protected] Masafumi Kato is an associate director in Market Access team in Takeda Pharmaceutical Company Limited in Japan. He joined this team in 2018. Mr. Kato has abundant experience as a biostatistician in the research & development area for over 10 years. He is currently engaged in several projects as a health economics specialist, and is especially in charge of the cost-effectiveness evaluation in the drug pricing system in Japan. Sarin KC Project Associate HITAP Thailand [email protected] www.linkedin.com/in/sarin-kc-904953a5/ Sarin is a health policy researcher at the Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Thailand. He supports the use of evidence for policymaking. His recent work includes RWD for reimbursement decisions, infectious disease modelling, digital health, cross-border travel, and strengthening the capacity to produce and consume evidence, among others. Prior to joining HITAP, Sarin worked as research analyst at the Ministry of Health and Population, Nepal and the London School of Economics and Political Science (LSE), UK. 48

Alison Keetley Attendees South East Asia Access and Access Policy Head Janssen Singapore [email protected] Ku Nurhasni Ku Abdul Rahim Pharmacist Ministry of Health Malaysia Malaysia [email protected] linkedin.com/in/ku-nurhasni-kar-55a412ab Ku Nurhasni Ku Abd Rahim is a registered pharmacist who graduated from the Universiti Sains Malaysia in 2005 and completed her master's degree in Health Economics and Decision Modeling from The University of Sheffield in 2014. Currently, she is the Head of the Health Economic and Value-based Unit in MaHTAS. Sang-soo Lee Sr. Director, Health Care Economics And Government Affairs Medtronic North Asia (South Korea and Japan) [email protected] www.linkedin.com/in/sang-soo-ss-lee-ph-d-mba-02903339/ Sang-Soo (SS) Lee, Ph.D., MBA, is Sr. Director, Health Care Economics and Government Affairs, Medtronic North Asia (Korea and Japan) and the head, Center of Expertise, Health Care Economics and Government Affairs, Medtronic Asia Pacific. SS manages health policy, reimbursement, health economics, and health technology assessment. Dr. Lee has held multiple positions at various organizations, such as a member of the Board of Directors at Korea Association of Health Technology Assessment (KAHTA); chair of the reimbursement committee at Korea Medical Devices Industry Association (KMDIA); chair of Market Access Working Group, APACMed; co- chair of the medical device committee at the American Chamber of Commerce (AmCham) in Korea; and adjunct professor at the Graduate School for Medical Device Management and Research, SAIHST(Samsung Advanced Institute for Health Science & Technology), Sung Kyun Kwan University, Seoul, Korea. 49

Attendees Matthew Lien Global Lead, Health Technology Assessment Intuitive United States [email protected] www.linkedin.com/in/matthew-l-103544126/ Matthew Lien is currently the Global Lead for Health Technology Assessment at Intuitive. Matt is responsible for leading all HTA related efforts involving Intuitive technologies, including global HTA strategy, management, and engagement. In this role, Matt works closely with regional leaders to support country specific efforts as well as broader market access initiatives globally. Matt has been at Intuitive for the past 2 years and has prior market access experience across the life science industry, including both pharmaceuticals and medical devices. Matt is a member of ISPOR and HTAi and participates within various interest groups. Matt holds a Doctorate in Pharmacy as well as a Master’s in Health Care Decision Analysis from the University of Southern California. Schezn Lim Health Economics and Market Access Manager Boston Scientific Asia-Pacific Singapore [email protected] www.linkedin.com/in/scheznlim/ Schezn Lim has more than 8 years of experience in healthcare, working across numerous settings from patient care as a hospital pharmacist, through to market access consulting, and currently as a Health Economics and Market Access Manager for Boston Scientific APAC. In her previous role as APAC Head of Market Access and Health Economics at Costello Medical Singapore, Schezn specialised in providing scientific support to the pharmaceutical and medical device industry, with specific expertise in HTA dossiers, health economic models, literature reviews, stakeholder engagement and publications. In her current role, Schezn is most passionate about applying her clinical training and technical knowledge of HEOR to solve real-world challenges in patient access to innovative health technologies. Schezn holds an MSc in Health Economics from the University of York, an MSc in Clinical Neuroscience from University College London, UK and a BSc in Pharmacy from the National University of Singapore, Singapore. Mondol Loun Deputy Director Department of Planning and Health Information Ministry of Health Cambodia [email protected] Mondol LOUN Female, 53years Cambodian, Buddhism, Medical Doctor and Master of Public Health Cambodia .Work at Department of Planning and Health Information ,Ministry of Health. Participate in Health Policy and Strategic development, Health indicators monitoring by health information system. 50