Submission of topics for re-evaluation of the benefits currently covered by the compulsory health insurance in Switzerland is now opened

Currently, health technology assessment (HTA) is not well organized in Switzerland. Giving a stronger role to HTA is one of the health policy priorities set by the Swiss Federal Council in its Health2020 initiative. HTAs facilitate transparent, evidence-based decision making, help to reduce ineffective and inefficient services, medicines and processes as well as raise the quality of healthcare and lowering costs.

Thus, the Federal Administration has launched an HTA program to re-evaluate benefits currently paid under the compulsory health insurance. This program will be extended and expanded progressively in the next few years.

The legal basis of the program is Article 32 of the Swiss Federal Health Insurance Act (KVG/LAMal), which specifies that medical products and services covered by compulsory health insurance must be effective, appropriate and economically efficient, and periodically reviewed to check whether these requirements are met.

The program to re-evaluate medical technologies (including pharmaceuticals and medical aids and equipment) focuses on reviewing potentially obsolete technologies paid under compulsory health insurance with the objective to remove them from the catalogue of benefits or limiting insurers’ liability to pay them (disinvestment).

This process will be systematic: the first step is to identify the topics, to pre-scope them (to determine the questions to be addressed in the report) and to commission an external body to produce both the scoping and the HTA report. These reports will support the relevant federal advising committees in their appraisal and in their recommendation to the Federal Department of Home Affairs (FDHA) or Federal Office of Public Health (FOPH). On the basis of these recommendations the FDHA, or in the case of pharmaceuticals the FOPH, will decide whether to remove, limit or continue the obligation to pay the benefit.

For the year 2018, the identification of the issues will last until October. Scoping is the next step and will last 6-9 months, and assessment will last another 6-12 months, after which the appraisal is done, and the decision is made.

Anyone can submit topics to be assessed for re-evaluation of the actual mandatory health insurance benefits at any time using the submission form, which can be found here in German language. The submissions are accepted until 30th of October 2018, after which they will be prioritized. Topics will be prioritised according to a range of criteria including the significance of the condition (disease burden), the budgetary relevance of the technology, any controversy concerning the efficacy or safety of the technology, indications of inappropriate care, the expected benefit (not just economic) of regulatory measures and the practicability of suggested improvements. Stakeholders will be consulted on the prioritization of the topics. The FDHA will decide which topics are to be addressed on the basis of the recommendation of the federal consulting committees.

See the full report in English (change to Italian, French or German in the top-right corner) here.

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