Assessing the performance of health technology assessment (HTA) agencies: developing a multi-country, multi-stakeholder, and multi-dimensional framework to explore mechanisms of impact

In 2015, the United Nations (UN) launched the Sustainable Development Goals (SDGs), aiming to achieve Universal Health Coverage (UHC) for everyone. Health Technology Assessment (HTA) plays a crucial role in this effort by evaluating the value of technologies in improving health relative to their cost. This enables countries, even those with limited resources, to prioritise health solutions that offer the greatest impact, ensuring that budget constraints do not hinder effective funding allocation.

Public organisations like the National Institute for Health and Care Excellence (NICE) in the United Kingdom (UK) and the Health Intervention and Technology Assessment Programme (HITAP) in Thailand, along with not-for-profit agencies like the Institute for Clinical and Economic Review (ICER) in the United States (US), form the backbone of this evaluation process. They transform data into actionable insights that shape the future of healthcare.

However, establishing and maintaining these agencies demands significant resources. While existing literature has addressed HTA’s impact, the studies are often heterogenous in their objectives, definitions of HTA and its impact, and the scope of evaluations depending on the national context. This variation complicates cross-country comparisons, and applying “linear” HTA frameworks in broader healthcare and economic evaluations can be challenging.

To address these limitations, the study re-examined the impact of HTA agencies by viewing HTA as an institution, rather than merely as a “knowledge product,” and developed an impact evaluation framework from a multi-dimensional, multi-stakeholder perspective. Nine experts from the global HTA community in Australia, Canada, Thailand, and the UK were interviewed to explore their views on the role of national HTA agencies. The data were analysed using logic modelling and impact mapping to identify and understand the mechanisms of change.

The study found that the main goal of an HTA agency is to support a cost-effective and equitable healthcare system. To achieve this, agencies need to pursue several key sub-objectives: conducting robust HTA studies, using HTA for agenda-setting and policy formation, engaging with external stakeholders, maintaining a good reputation and integrating seamlessly into the healthcare and policy-making system, using HTA as a negotiation tool for health technology pricing, and effectively implementing policy changes related to health technologies. The study also proposed indicators for each sub-objective and suggested testing the framework across various scenarios beyond healthcare systems.

The findings and the framework developed offer a fresh perspective on how HTA agencies impact the delivery of UHC. This can be useful for countries considering the establishment or management of national HTA agencies, as well as for development partners funding HTA initiatives.

To learn more about the study, please find the link here: Assessing the performance of Health Technology Assessment (HTA) agencies: developing a multi-country, multi-stakeholder, and multi-dimensional framework to explore mechanisms of impact | Cost Effectiveness and Resource Allocation | Full Text (biomedcentral.com)

Acknowledgements
This article has been reviewed by Tanainan Chuanchaiyakul, Natcha Kongkam and Serah Clarence.