The Transformative Role of Health Technology Assessment (HTA) in Advancing Precision Medicine (PM) Across Asia
The rapid rise of precision medicines (PMs) is transforming healthcare but poses challenges for Health Technology Assessment (HTA) systems due to lagging clinical and economic evidence. In this exclusive conversation, Dr. Chen Wenjia from NUS and Nordin Charafi from Illumina examine the PM landscape in Asia-Pacific, noting that most evaluations still rely on conventional HTA methods, with challenges stemming from evidence gaps and substantial budget impacts. As PMs become mainstream, HTA systems must adapt by strengthening post-market data collection, expanding frameworks to capture PMs’ unique value, and implementing risk-sharing agreements. Adoption varies across the region, requiring a balance of affordability, equity, and local constraints for sustainable integration.
1. Your research focuses on advancing economic evaluations for precision medicine and AI-enabled technologies. What key methodological shifts are needed in HTA to appropriately capture the long-term value of PM?
Dr. Chen Wenjia: Although PM has various applications, the core paradigm is to stratify individual risk and/or treatment responses, which challenges traditional HTA methods that focus on average treatment effects. Thus, the current HTA determines the value of PM based on the downstream therapies. HTA should shift toward mapping PM-centered clinical pathways, patient-level simulation to capture long-term to intergenerational value, and use of real-world PM-focused evidence with standardised causal inference. Evaluation should reconsider patient-centred value beyond treatment benefits, and ethical and equity aspects should be integrated to reflect broader societal implications.
2. From a payer and policy perspective, how can governments accelerate reimbursement readiness for precision medicine without compromising HTA rigor?
Nordin Charafi: Governments can accelerate reimbursement readiness by integrating post-HTA data collection systems to monitor outcomes and enable periodic reassessments. For example, Australia requires post-approval evidence collection and reassessment within three years for high-cost interventions. Risk-sharing agreements (RSAs), such as those used in South Korea and Japan, align payments with proven clinical value to ensure affordability. Adapting HTA frameworks to incorporate real-world evidence (RWE) and broader societal impacts, helps capture precision medicine’s value. These measures balance patient access to innovative therapies with maintaining HTA rigor.
3. Given the frequent early evidence gaps in PM, how can HTA processes better incorporate adaptive or sequential evidence-generation approaches?
Dr. Chen Wenjia: To address early evidence gaps in precision medicine, HTA processes can integrate adaptive approaches by embedding post-HTA data collection systems for continuous outcome monitoring. Effectively utilising RWE helps bridge these gaps. Additionally, fostering collaboration through regional initiatives like HTAsiaLink promotes shared learning and streamlines evaluations of emerging therapies, adapting to the evolving PM landscape.
4. Given your experience across multiple regions, what lessons from European HTA ecosystems could be effectively adapted to Asian contexts for PM adoption?
Nordin Charafi: One key takeaway from Europe is the use of conditional or provisional funding mechanisms to bridge evidence gaps and enable the clinical adoption of precision medicine (PM) technologies. Countries like France and Germany have implemented programs that provide temporary reimbursement, contingent on the collection of real-world data (RWD) to assess clinical and economic value. This dual-track approach, i.e. adoption alongside evidence generation, ensures that innovation reaches patients while supporting informed, fit-for-purpose HTA reassessments.
In Asia, emerging initiatives demonstrate a growing commitment to strengthening data ecosystems, creating new opportunities for collaboration among key stakeholders. With continued engagement from patients, clinicians, providers, industry, and policymakers, the region is well positioned to build and sustain a robust, interoperable data infrastructure. As this foundation takes shape, real-world evidence can increasingly serve as a credible basis for reimbursement decisions and accelerate long-term PM adoption
5. Clinical decision support tools are pivotal in personalised care. What challenges do you see in integrating these tools into HTA frameworks across Asian health systems?
Dr. Chen Wenjia: Clinical decision support tools mainly benefit the process of care, such as the value of information about prognosis, which challenges the traditional cure-based HTA paradigm not only in Asia but also globally. A major challenge is the empirical weakness of QALY (Quality adjusted life years)-based methods and subsequent decision thresholds, because utilities typically measure health gains but do not reflect insurance value (value of potential risk reduction) and the benefits from the process of care. Another HTA consideration across Asian health systems is the lack of methodology guidelines to collect evidence.
6. Budget impact concerns remain a major barrier. How can risk-sharing or pay-for-performance agreements be strategically designed for PM uptake in resource-diverse Asian markets?
Nordin Charafi: Strategically designing RSAs for PM in resource-diverse Asian markets involves tailoring agreements to balance clinical innovation, local infrastructure and affordability. Outcome-based RSAs, like those in South Korea, link reimbursement to predefined treatment goals, ensuring payments correspond to real-world performance. But they can’t be implemented across Asia as they rely on data infrastructure that allows for measuring the impact of a health intervention on patients’ outcomes. Pay-for-performance schemes, such as Australia’s instalment-based payments for high-cost therapies, reduce financial risks by tying payments to sustained outcomes. Therefore, careful consideration of local contexts and broader systemic challenges is essential when implementing these types of innovative payment methods, which may not be universally applicable across all Asian markets.
7. From a health economics standpoint, how should HTA bodies in Asia rethink cost-effectiveness thresholds in the context of high-cost genomic and precision-based therapies?
Dr. Chen Wenjia: HTA bodies in Asia should rethink cost-effectiveness thresholds by factoring in the unique value propositions of genomic and precision-based therapies and potentially disease severity. This includes incorporating broader societal benefits, such as long-term health gains and potential intergenerational impacts. Benefits of the wider economy (e.g., productivity). Additionally, RSAs and innovative financing schemes can also mitigate financial pressures while supporting equitable access.
8. You work closely with health systems on genomics adoption. What are the most common misconceptions payers have about the value of PM, and how can HTA frameworks help address them?
Nordin Charafi: Payers commonly misunderstand the value of PM, expressing concerns about its cost-effectiveness, high upfront payments, and long-term benefits. But there are solutions to mitigate these concerns. In my opinion, HTA frameworks can help by providing robust evidence that demonstrates the clinical and economic value of PM, including real-world patient outcomes. It can also support RSAs linking reimbursement to patient outcomes, and thus, mitigating concerns about high initial costs. But most all, it is important to foster payer engagement early in HTA processes to dispel concerns about PM’s affordability and impact.
9. You’ve worked extensively on modeling chronic diseases and multimorbidity. How can such models help predict the broader policy impact of adopting precision medicine at scale?
Dr. Chen Wenjia: I envision future PM evaluation to be PM-focused, modelling its entire risk- and/or treatment-stratified clinical pathways and spillover effects over the long term. Clinical trials may be difficult to replicate such a process, but RWE holds the key. My work on the population health economics of chronic diseases and multimorbidity relies on causal inference on national health claims data, which creates counterfactual frameworks, modelling lifetime care, costs and outcomes. These prepared PM-centered trial emulation in real-world data, which will more comprehensively capture the long-term impact and potential cost savings of PM at a population level.
10. Equity in PM access varies widely across Asia. What policy levers or financing strategies do you see as most impactful in narrowing this gap?
Nordin Charafi: Narrowing equity gaps in PM access across Asia requires policy levers and financing strategies such as flexible pricing mechanisms, including value-based pricing and subsidies for low-income populations. Regional partnerships like HTAsiaLink can help share HTA best practices. Countries like Singapore, South Korea, and Australia have implemented risk-sharing agreements and post-HTA data collection systems, which can serve as models for ensuring equitable access to high-cost PM interventions.
11. Post-market data collection is a major gap in Asia. What types of RWE infrastructures or data governance frameworks are most urgently needed to support HTA for PM?
Dr. Chen Wenjia: To address post-market data gaps in Asia, robust RWE infrastructures are essential. Registry-based systems, like those in Australia and South Korea, can monitor outcomes and assess long-term value of PM. Standardised data-sharing platforms, backed by strong governance frameworks, ensure interoperability and compliance with privacy regulations. Collaborative regional efforts, such as HTAsiaLink's HTA registry, can streamline data collection and reduce duplication, enabling evidence-driven HTA for PM innovations.
12. HTA systems in Asia still rely heavily on traditional methods. What coordinated reforms do you believe are essential to ensure HTA keeps pace with emerging precision technologies?
Dr. Chen Wenjia: HTA systems in Asia must evolve by integrating dynamic evaluation frameworks that capture the unique value of precision medicine. Establishing postmarket data collection systems, fostering regional collaborations and adapting cost-effectiveness thresholds to align with societal perspectives are crucial reforms for keeping HTA relevant in the face of emerging technologies.
Nordin Charafi: To ensure HTA keeps pace with precision technologies, reforms should prioritise real-time evidence generation, genomic data integration, and flexible reimbursement models such as outcome-based agreements or budget-capped models. There’s a need to build scalable data platforms and foster cross-border cooperation to drive innovation while ensuring affordability across Asia.
13. Collaboration between HTA agencies, policymakers, and industry is becoming increasingly important. What models of multi-stakeholder partnerships do you consider most effective for PM integration?
Dr. Chen Wenjia: An effective model for multi-stakeholder partnerships is a regional collaboration framework where HTA agencies, policymakers, and industry co-develop post-market data systems. By pooling resources, sharing real-world evidence, and aligning goals, such partnerships can address gaps in evidence, affordability, and scalability crucial for precision medicine adoption across diverse healthcare ecosystems.
Nordin Charafi: Public-private partnerships are key, where industry provides technological expertise and data, while HTA agencies and policymakers focus on evaluation frameworks and equitable access. Collaborative models like shared genomic databases and outcome-based agreements can accelerate precision medicine integration while ensuring cost-effectiveness and wide-reaching societal benefits for patients and healthcare systems.
14. Looking ahead, what does a “future-ready” HTA ecosystem for precision medicine in Asia look like, and what actionable steps must stakeholders take today to build it?
Dr. Chen Wenjia: A future-ready HTA ecosystem integrates real-world evidence, adaptive cost-effectiveness frameworks, and regional collaboration. Stakeholders must invest in workforce training, develop interoperable data platforms, and align evaluation standards. Institutions like NUS aim to drive capacity-building and foster multidisciplinary partnerships to ensure precision medicine delivers equitable, long-term impact across Asia.
Nordin Charafi: A future-ready HTA ecosystem embraces robust data integration, streamlined evaluation processes, and stakeholder collaboration. Today’s priorities include establishing genomic data-sharing frameworks, fostering public-private partnerships, and modernising policy pathways. Illumina is committed to supporting these efforts by advancing genomic technologies and building evidence for the transformative value of precision medicine.
