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Meeting round-up: HTAi 2021

My second virtual conference of the season, HTAi 2021, took place over five days in June. At first login, the meeting platform presented itself as one of the more easily navigable virtual conference platforms, with everything accessible from a single dashboard. It included lots of clever features. It even gamified engagement, with the opportunity to earn points by attending sessions and asking questions. Looking at the scores, some people were highly incentivised by this.

Despite (or perhaps because of) this cleverness, there was a wide variety of technical problems throughout the conference. Videos didn’t play, unwanted messages appeared in front of slides, people were cut off when the scheduled duration was up. Nevertheless, attendees made good use of the functionality. There was some excellent discussion in the chat sections, mostly from a small group of HTAi devotees.

I recently wrote about ISPOR 2021, and there was a lot of similarity in the topics covered at this meeting. The theme for the meeting was Innovation Through HTA. Unsurprisingly, there was a lot of focus on COVID. As with ISPOR, sessions are available on catch-up. However, it is not possible to directly link to sessions. Most are on YouTube but unlisted so, if you ask someone nicely, they might provide you with the link.

The first plenary led with the theme of innovative methods. A lot of this related to speed, which has been the dominant factor during the pandemic. Not just speed in approvals, which makes the headlines, but the speed in recruiting patients, doing research, and getting results out there. Martin Landray spoke about the RECOVERY trial and ran through some of the drugs that have helped ease the impacts of the pandemic. Anna Gagliardi set out some practical tools and approaches to developing and adapting guidelines, especially when evidence is lacking. Tracy Merlin considered whether the approaches adopted in response to COVID should survive into the future. The session could have been called ‘collaborative methods’ rather than innovative methods, as collaboration was the clear focus. Accelerated forms of collaboration, both horizontal (e.g. across different groups and regions) and vertical (e.g. between regulators and HTA and clinical guideline development), are probably here to stay. The pandemic has hurried that along.

The second plenary on patient involvement was, for the most part, a traditional plenary, in which the speakers stated the bleeding obvious. Still, there were a few useful nuggets. Sophie Staniszewska outlined the need to specify clearer frameworks, which makes for good research fodder. Eva Maria Ruiz de Castilla provided an intriguing take on conflicts of interest from Latin America. The session was plagued by technical problems, but there was still a lot of discussion.

The keynote speech format worked well in the virtual setting. These were short and (for the most part) engaging. For example, Neil Bertelsen guided viewers through a flashback to the beginning of the AIDS epidemic, comparing it with the COVID-19 pandemic. I didn’t much appreciate his suggestion, citing discrimination against Asian communities, that society’s response to the COVID-19 pandemic has been as bad or worse than the response to the emergence of AIDS. But I do like a talk that I can disagree with.

I attended quite a few enjoyable and informative panel sessions. As usual for HTAi, the emphasis was on policy and practice rather than the vagaries of academic thought. PN15 was on ‘reassessment and disinvestment’. I was hoping for some analysis of how agencies ought to pursue such objectives, but the session mostly provided examples of conditional approvals and unwarranted variation in practice. I was interested in the UK-specific talk from Zharain Bawa and Aoife Molloy on the Evidence-Based Interventions Programme. On a similar note, Iñaki Gutierrez Ibarluzea presented ‘not to do’ recommendations from Spain. And I especially enjoyed Line Evensen‘s presentation about the Norwegian experience of developing models for disinvestment, inspired by the EBI programme in England.

Evidently, I can’t get enough of watching Koonal talk about measuring and valuing children’s quality of life. This session was a little more rounded and less focused on research than other sessions I’ve seen, and its value lay in its mix of speakers. Claire Wright set things up brilliantly with a talk about meningitis, providing a clear rationale for thinking harder about this topic. A meningitis B vaccine was found to be not cost-effective at zero price in the UK, partly because the measurement of quality of life – based on the EQ-5D – was seemingly not appropriate. Claire signposted various issues from this example, such as the public’s prioritisation of treating infants, the relevance of more severe states, discount rates, and plenty more. Koonal’s talk focussed on the available instruments and the normative challenges associated with their use, and how these relate to the new EQ-5D-Y valuation protocol. Donna Rowen continued this theme around research priorities and how we might reconcile adult and child quality of life. Ernest Law from Pfizer provided an industry perspective, outlining his concerns and priorities and some practical advice from outcomes researchers in industry. In a poll on research priorities, the largest proportion voted for ‘involving children in child health valuation research’. I asked a question about why so little stated (health) preference research is conducted with children. For me, Donna hit the nail on the head, stating that we need to do better and “be more brave”; we should have more faith in the kids.

Another good panel session – PN38 – was on outcome-based managed entry agreements (or whatever you prefer to call them), focusing on a European project. There was lots of talk about Spinraza and the differences in what countries decided and how they decided it. The most practically useful bit for me was Emma Kent from NICE outlining the UK policy context. It was also interesting to hear from Piia Rannanheimo about the Finnish context, where hospitals tend to manage MEAs. Karen Facey, who seemingly leads the European study, proposed a portal for sharing data collection strategies for MEAs.

I enjoyed plenty of other useful content too, including a panel (PN19) on work to develop a definition of deliberation in HTA and a checklist for its use. This post consists of just a few of my highlights.

All of the research submissions – oral and poster presentations – were grouped in a repository of on-demand sessions. These were mostly a disappointment. Many of the on-demand talks had unbearably bad audio quality. Some of the presentations (oral and poster) were just not there. This is presumably because the authors had not uploaded their presentation, or – as I saw in at least one case – they had provided their YouTube link in the wrong format. As with ISPOR, the interface was a drag. Browsing was not easy, and the interface prioritised style over function. I had two presentations (you can watch one of them on YouTube) and didn’t get a sniff of engagement.

Attendance at the meeting cost $605. While I enjoyed most of the sessions, the meeting didn’t represent good value for money. I should say that the organisers provided a host of social and leisure activities, from a mixology class to live music, which I missed. I’d’ve loved to have taken part – honestly – but I just didn’t have the time. Hopefully, HTAi won’t need to do another virtual conference; it is much better in person.

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