Including health technology assessment in the decision-making process of the Peruvian social security healthcare system: The IETSI experience.

Abstract

Public health systems have the great challenge of meeting the population's health needs with limited financial resources. Thus, to incorporate new health technologies (HT) in their coverage plans, they use tools that allow them to inform their decisions based on scientific evidence, such as health technology assessments (HTAs). These are developed in a multidisciplinary way, under an explicit methodology, which estimates the value of a technology. With this information, the decision-maker can support his decision, anticipate the impact of its implementation, plan actions, and set goals, all of which promote efficient use of resources, transparency of processes, and facilitate accountability.

The Peruvian Social Security healthcare system (EsSalud) implemented, through the Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI), a decision-making process based on HTAs to decide on the coverage of new HT. From the creation of the IETSI in December 2014 to December 2021, 407 ETS have been carried out. Of these, 161 were approved, thus extending new treatments for clinical conditions. These incorporations have not translated into a sharp increase in the annual expending of medicines to put EsSalud's financial sustainability at risk, although it has increased patient access to innovative technologies. The average investment per patient treated with these technologies was reduced from S/ 133,270 in 2011 to S/ 47,779 in 2019.