Long-awaited tech review back on track

Dr Peter Boxall has been replaced as the proposed head of the Health Technology Assessment Review.

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Australia’s long-awaited Health Technology Assessment Review appears to be back on track, more than six months after the former Morrison government controversially appointed longstanding PBS critic Dr Peter Boxall to head its proposed reference committee.

Dr Boxall has been dumped from the line-up, with Health Minister Mark Butler announcing the finalised committee would be chaired by Adjunct Professor Debora Picone, who recently retired as CEO of the Australian Commission of Safety and Quality in Health Care.

The announcement has been welcomed by Medicines Australia CEO Elizabeth de Somer, who told The Medical Republic there had been discussion about whether Dr Boxall “was going to be the right person from the stakeholders’ perspective”.

“Mark Butler did commit to review the appointment of Peter Boxall and I think that this been led by the minister’s recognition that there were some challenges in that stakeholder and Medicines Australia consultation on the on the chair, and also some concerns raised by stakeholders about his appointment,” she said.

“I think they took a fresh sheet of paper and looked at whether they would find someone more suitable, and they worked very collaboratively with us on the proposals and were willing to consider the people that we put forward as well, so it was a collaborative decision.”

Ms de Somer said she supported Professor Picone’s appointment.

“Adjunct Professor Picone is an independent, pragmatic thinker who has a consultative nature. She is a highly respected leader in public administration and understands the important role of patients,” she said.

“We look forward to working with her to deliver on much needed health reform that will speed up access to innovative medicines, vaccines and therapies.”

Other confirmed committee members include Professor Andrew Wilson (chair of the Pharmaceutical Benefits Advisory Committee), John Young (industry representative, retired senior Pfizer executive and former Medicines Australia chair), Professor Andrew Roberts (clinical/scientific representative), Adriana Platona, (government nominee, also the first assistant secretary of the Department of Health and Aged Care’s Technology Assessment and Access Division), Ann Single (patient representative) and Dr Dawn Casey patient representative.

All but Professor Picone were on the original committee formed by the Morrision government and announced by former health minister Greg Hunt on the same day as the federal election was called.

Opponents to Dr Boxall’s proposed appointment questioned the timing of the announcement, and also claimed he was the wrong choice to lead the review given his role as one of five commissioners that led the Abbott government’s National Commission of Audit. The audit was a response to the government’s inherited $123 billion in projected deficits from the previous Labor government.

Their report, delivered in 2014, recommended the introduction of new arrangements for funding the PBS, the establishment of an independent PBS authority which would oversee management of subsidised pharmaceuticals within the Australian health system, and increasing co-payments for all medicines under the PBS, including for concessional medicines that had been free.

Following the announcement on 10 April, then Opposition health spokesman Mark Butler said Labor did not accept the appointments and if elected, would go back to the drawing board and consult further with stakeholders.

This week he made good on his promise.

“Adjunct Professor Picone will deliver a HTA Review that will keep HTA in Australia at the forefront of public health and ensure Australians continue to enjoy the best possible access to health technologies, at a cost consumer and the public can afford,” Mr Butler said in a statement.

“I look forward to the work of this important review and will considering its findings.”

He said the deadline for completion of the review would be extended to 31 December 2023, to account for the delay in finalising the committee.

The government committed to a review of the HTA system last year, with a clear goal to reduce the time it takes for Australians to access new health technologies. It is to be the system’s first major overhaul in 30 years.

Under the terms of the agreement between the Commonwealth and Medicines Australia, the independent HTA review will look at current policy and methods used by PBAC to assess new medicines for listing on the PBS, contemporary research, and relevant methodologies and purchasing practices used by comparable international jurisdictions.

“The HTA review is a mutual acknowledgement by the government and the medicines industry that medical technology is progressing rapidly, and a step change is required to keep pace with advances in science as well as continuous evaluation and improvement to help ensure access as early as possible to the most effective medicines for all Australians,” the agreement states.

Ms de Somer told TMR the first job for the newly minted committee would be to develop terms of reference for the review.

“I’m confident that it’s a small committee, it’s got strong consumer representation, and I’m confident that there is expertise and quality of understanding of the system,” she said.

“And the biggest job that this committee have, which will set the tone for the whole workload is developing those terms of reference.”

Clinicians would have an important role to play in the review process, she said.

“They’re the ones who are seeing patients who are missing out on new treatments or suffering from treatments that don’t quite fit them and aren’t quite working, and they’re the ones who are going to be making the decisions about prescribing new technologies and new treatments when they become available,” she said.

Ms de Somer said there would be opportunities for clinicians and other stakeholders to engage with the review and she urged as many as possible to be part of the process.

“The more that clinicians can identify and engage with the process to demonstrate how access to new medicines will actually in contribute to productivity and workforce participation, the greater chance we have of real change,” she said.

“We really do think that the clinician community does need to be engaged in this because they will benefit and patients will benefit from that the economy and the workforce will benefit.”