HTA projects

All HTA projects in progress or completed are listed below. Published here in the course of each project are the protocol and the HTA report, together with the feedback received from stakeholders. The reports are written in English (with summaries in French, German and Italian).


Prevention of chronic and episodic migraine with CGRP antagonists

Various treatment options are available for prevention of chronic and episodic migraine. In addition to beta blockers, calcium antagonists and antidepressants, these include monoclonal antibodies known as CGRPs. The report concludes that the use of CGRP antagonists reduced the number of migraine days overall, and more than halved the number of migraine days and improved the quality of life of more people versus placebo and supportive measures in the control group. A reduction in the price of CGRP antagonists would significantly improve the cost-benefit ratio and thus reduce the impact on the cost budget.


Comparison of surgical improvement of vascular blood flow with drug therapy in subjects with chronic cardiovascular disease

In addition to medication, surgical interventions to improve vascular blood flow are another means used to treat chronic cardiovascular disease. Surgeons will either perform heart bypass surgery or insert tubular vascular stents into the narrowed blood vessels. The report concludes that heart bypass surgery is superior to drug therapy alone. For tubular vascular stents, the benefit was less clear and only demonstrated in the short term.


Treatment duration of Trastuzumab in early HER2-positive breast cancer

The drugs trastuzumab and pertuzumab are used in Switzerland to treat breast cancer if cancer cells overexpress the HER2 receptor. The approved treatment duration of trastuzumab is a maximum of 12 months and can be started before or after surgical removal of cancer cells. An HTA report was commissioned to evaluate the reimbursement requirement with the aim of reviewing the efficacy, safety, cost-effectiveness and budgetary impact.


Folate tests for suspected folate deficiency

This HTA report examines the safety, the effectiveness, the costs and the cost-effectiveness of conducting folate tests on symptom-free persons and on persons for whom symptoms, medical problems or other factors suggest a possible folate deficiency. The report further examines ethical, social and organisational issues in connection with folate testing.


CAR-T-cell therapies

The CAR T cell therapies tisagenlecleucel (Kymriah®) and axicabtagene ciloleucel (Yescarta®) are provisionally listed in Appendix 1 of the Health Insurance Benefits Ordinance, and are reimbursed by Swiss mandatory health insurance for the treatment of diffuse large B cell lymphoma (DLBCL; Kymriah® and Yescarta®), B cell acute lymphocytic leukaemia (ALL; Kymriah®) and primary mediastinal B cell lymphoma (PMBCL; Yescarta®). To inform future reimbursement decision an HTA will be conducted with the aim of evaluating the safety, efficacy/effectiveness, costs, cost-effectiveness and budget impact of tisagenlecleucel and axicabtagene ciloleucel separately in these indications. In addition, ethical, legal, social and organisational issues associated with these therapies will be investigated.


Oral anticoagulants for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation

Oral anticoagulants are administered to persons with atrial fibrillation to prevent strokes. As part of an HTA, the use of direct oral anticoagulants (DOACs) was compared to that of vitamin K antagonists (VKAs). Studies suggest that DOACs are slightly more effective than VKAs in total mortality terms. Improvements were observed in the prevention of bleeding, while the difference between the two types of anticoagulant was only minor in stroke prevention terms. While more expensive, DOACs showed a superior benefit-cost ratio compared to VKAs.


Tumor treating fields (TTFields) for patients with glioblastoma

In Switzerland, tumour treating fields (TTFields) for the treatment of newly diagnosed glioblastoma are reimbursed through the statutory health insurance under certain circumstances. To evaluate the reimbursement obligation, a HTA was commissioned with the aim of investigating the efficacy, safety, cost-effectiveness and budgetary impact of TTFields for patients with glioblastoma. As well as the use of TTFields for newly diagnosed glioblastoma, the HTA also examines their use in recurring glioblastoma. The ethical, legal, organisational and social aspects of treatment with TTFields are also evaluated in the HTA report.


Hormone tests in suspected thyroid dysfunction

Where thyroid dysfunction is suspected, testing for thyroid hormones may provide useful insights. Two test approaches exist: the one-step test measures thyroid-stimulating hormone (TSH) and other thyroid hormones in a single step, while the two-step approach measures just the TSH to begin with. The report concludes that, from a clinical perspective, using the two-step testing approach carries only a low risk of missing cases of thyroid dysfunction. In terms of costs, the two-step approach represented a cost saving compared with the one-step approach.


Use of the hormone Levothyroxine to treat a slightly underactive thyroid gland

One sign of a slightly underactive thyroid gland is a raised level of the hormone which stimulates the thyroid – known as thyroid-stimulating hormone, or TSH. The hormone levels in the thyroid are still within the normal range at this stage and symptoms are only minimal. To treat this condition in Switzerland, a manufactured form of the body’s own thyroid hormone is used – the hormone Levothyroxine. The report concludes that treatment with Levothyroxine successfully reduces the level of the TSH hormone, but does not reduce the associated complaints or side effects.


Medications against dementia in Alzheimer’s and Parkinson's disease

This HTA report investigates the efficacy of various anti-dementia medications for the treatment of dementia symptoms in Alzheimer’s and Parkinson's disease. Literature searches found that in mild to moderate and in some cases also in advanced dementia in Alzheimer’s and Parkinson's disease, the anti-dementia medications used had a certain positive effect, for example on cognitive abilities, compared to placebo. Considered over a longer period, the cost/benefit ratio for most of the anti-dementia medications was positive.


Comparison of dosing schedules for drugs to treat bone metastases

Cancer sufferers with bone metastases receive drugs on a monthly basis to reduce the risk of fractures and the release of excess calcium into the bloodstream. The latest studies indicate that administering the drugs only every three months rather than every month is similarly effective but is associated with a lower risk of side effects. Comparing trimonthly to monthly dosing, the analyses only showed minimal differences in terms of potential side effects while the efficacy was the same. If doctors treated patients on a trimonthly dosing interval from the outset, this would result in potential savings of over CHF 53 million in the next five years.


Denosumab (Prolia®) for the treatment of osteoporosis

Denosumab (Prolia®) is used to treat bone loss, particularly among women after the menopause and people who are at a higher risk of breaking bones or who are undergoing certain cancer treatments. In 2017 there were reports that stopping therapy with denosumab could lead to excessive counter-reactions such as loss of bone density and a greater risk of broken bones in the area of the spine. The report concludes that among most of the patient groups treated, denosumab achieved similar effects to other therapies and displayed a similar degree of safety.


Sedative and sleep-promoting medicines for the treatment of chronic sleep disorders

The group of sedative and sleep-promoting medicines is used in sleep disorders in order to alleviate persistent episodes of tension and anxiety. According to the product information they should not be prescribed for longer than four weeks. According to the report, the evidence indicated that the drugs remain effective to a certain extent and are safe even during long-term use, but that they are not necessarily cost efficient. The use of sedative and sleep-promoting medicines leads to dependency and increasing doses.


Multigene-expression tests for breast cancer

This topic is currently in development. As soon as reports on this topic are available, they will be published here.


Vitamin B12 tests

The use of vitamin B12 tests in Switzerland has risen sharply in recent years. The aim of the report was to identify the advantages and disadvantages of various vitamin B12 tests and establish whether tests are needed at all before dispensing vitamin B12. The report concludes that the existing findings do not indicate whether a vitamin B12 test or test combination should be used, and if so which ones, or whether the tests have any influence on the treatment.


Magnesium supplements

This topic is currently in development. As soon as reports on this topic are available, they will be published here.


CDK4/6 inhibitors as a treatment for advanced breast cancer

CDK4/6 inhibitors are a relatively new class of drugs often used for advanced metastatic breast cancer in combination with anti-hormonal therapy to complement standard treatment. New studies indicate that not all CDK4/6 inhibitors contribute equally to prolonging survival of breast cancer patients or to improving their quality of life. The report concludes that the combination therapies consisting of CDK4/6 inhibitors and standard therapy can increase efficacy but will increase the need for medical care and produce more side effects. Further studies are ongoing and might produce more detailed results in future.


Infliximab reference product versus biosimilar for the treatment of rheumatoid arthritis

The biopharmaceutical infliximab is a monoclonal antibody (mAb) used to treat a number of inflammatory autoimmune diseases including rheumatoid arthritis (RA). In 2019, infliximab generated costs of around CHF 132 million, rendering it the second most cost-incurring drug reimbursed by the mandatory health insurance in Switzerland.
Some European countries adopted policies recommending the substitution of infliximab reference products with biosimilars like initiating treatment with infliximab biosimilars as well as switching patients from infliximab reference product to biosimilars. In Switzerland, the legal framework does not facilitate implementing similar policies.
The aim of the HTA is to evaluate the efficacy, safety, cost-effectiveness and budgetary impact of initiating treatment with infliximab biosimilars as well as of switching patients from infliximab reference product to biosimilars in rheumatoid arthritis patients.


Antidepressants and cognitive behavioural therapy in major depressive disorders beyond the acute treatment phase

The topic was proposed concurrently by both the FOPH and the Swiss Medical Board (SMB) as an HTA topic for evaluation. As the SMB report covers the same research questions as were planned by the FOPH, the FOPH has decided that the SMB will take on the report.


Surgical widening of the subacromial space for the treatment of lower shoulder pain

A suspected cause of pain below the shoulder blade is insufficient space between the shoulder blade and the shoulder joint. One possible treatment is surgical widening of the subacromial space. The report concludes that surgical widening of the subacromial space offers no significant advantages over the conservative approach. However, the alternative treatment with physiotherapy may result in cost savings.


Statins in the primary prevention of cardiovascular events and mortality in Switzerland

The Health Technology Assessment (HTA) report on statins for the primary prevention of cardiovascular events and mortality in Switzerland. This is done on the basis of the identified number and quality of the primary literature. Based on the scoping report, the HTA report examines the efficacy, safety, cost-effectiveness and budgetary impact of statin therapy in adults without established cardiovascular disease at low, moderate or (very) high cardiovascular risk compared to no treatment and/or lifestyle adjustment.


The treatment of hypercholesterolaemia and mixed/combined hyperlipidaemia with ezetimibe-containing medicines

The aim of the Health Technology Assessment (HTA) is to evaluate the efficacy, safety, cost-effectiveness and budgetary impact of ezetimibe-containing medicines compared to statins or fenofibrate in patients with hypercholesterolaemia or mixed/combined hyperlipidaemia.


Long-term physiotherapy after a stroke, in multiple sclerosis or Parkinson's disease

In Switzerland, the compulsory health insurance system pays for up to 36 physiotherapy sessions. However, many patients require longer-term physiotherapy, for example after a stroke or if they suffer from multiple sclerosis (MS) or Parkinson's disease. A report was designed to show whether long-term physiotherapy with more than 36 sessions offers any therapeutic advantage over short-term physiotherapy. The preliminary report showed that, for the aforementioned groups of patients, the data currently available are insufficient for producing a comprehensive report comparing long-term physiotherapy with short-term physiotherapy after a stroke, in multiple sclerosis or Parkinson's disease.


Vertebroplasty or kyphoplasty in patients with symptomatic osteoporotic vertebral compression fractures

The objective of this HTA is to evaluate the efficacy, safety, cost-effectiveness and budgetary impact of percutaneous vertebroplasty and percutaneous balloon kyphoplasty in patients with symptomatic osteoporotic vertebral compression fractures unresponsive to non-surgical treatment.

Examples for search terms:
osteoarthritis or osteo* or *arthritis 

Last modification 02.09.2022

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Federal Office of Public Health FOPH
Health insurance benefits Division
Health Technology Assessment Section
Schwarzenburgstrasse 157
3003 Bern
Tel. +41 58 469 17 33

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