Mapping presence of Health Technology Assessment and Private sector-Led Submission mechanisms

Health Technology Assessment (HTA) is widely used as a decision tool to support and inform policy-making processes. There are challenges and variations across settings and healthcare technologies (e.g., medications, biologics, devices, procedures, public health programs) which have encouraged stakeholders to explore new ways to support HTA and policy-making process. One potential approach is through Private sector-Led Submission (PLS), whereby private sector can generate, fund, and/or submit clinical and economic evidence to inform reimbursement and coverage decisions.

Discussion on the importance of HTA institutionalization has been mentioned before [1]. WHO survey and GEAR website have listed countries, territories and areas (CTA) with established HTA in policy-making process [2, 3]. To our knowledge, information on whether CTA accept PLS in their HTA process has not been published.

Therefore, this blog raises an important question: How many countries, territories and areas (CTA) are PLS used to support the HTA process? The literature review below provides some insights into this question.

Global Landscape

Figure 1. Mapping of HTA status by Countries, Territories and Areas (CTA)

As part of an upcoming manuscript by the Health Intervention and Technology Assessment Program Foundation (HITAP) examining the advantages and disadvantages of PLS, we conducted a literature review of national organizational reports and/or published articles about HTA and PLS implementation from 220 CTA worldwide, classified according to the World Bank’s Economies [4], as shown in Figure 1. An online dashboard is also available for readers who would like to explore the HTA and PLS implementation at the level of individual in more detail: https://www.hitap.net/wp-content/uploads/2026/09/HTA_PLS_Dashboard.html 

The review found that almost half (100 CTA (45%)) have implemented HTA systems. Among these CTA, 48 implemented HTA without a PLS mechanism, while another 52 have integrated HTA with PLS mechanisms. In addition, the status in 29 CTA remains unclear and that it could not be determined from the search. These findings highlight global presence of HTA to inform policy-making processes, with lacking HTA frameworks unlikely to implement PLS mechanisms.

Although PLS may improve the efficiency of the HTA process by enabling more timely assessments, expanding the generation and submission of clinical and economic evidence, and strengthening industry capacity to prepare evidence dossiers, it also raises important concerns, particularly in settings with limited HTA review capacity. These concerns were mentioned at the consultation meeting among stakeholders in Thailand (with in-depth interviews with other HTA agencies in process), include potential conflicts of interest and biased evidence submitted by private sectors [5]. Therefore, strengthening HTA capacity and governance should be a prerequisite for CTA considering the adoption of PLS.

For readers interested in working in a CTA with an HTA system but without a PLS mechanism, an upcoming manuscript will provide the framework that can help identify the key considerations for PLS adoption. The following resources provide example PLS mechanism from Singapore, providing useful example of how HTA systems operationalise PLS through structured submission, appraisal, and review processes. This example illustrates how PLS can function within a broader HTA ecosystem that maintains methodological rigour, transparency, and independent oversight.

Link to full paper with specific reading guidance.

An example of the PLS process in Singapore is presented in the document “Company submission to ACE” can be accessed via: Company submissions to ACE - ACE's methods for evaluating healthcare technologies and providing clinical guidelines to support Singapore's healthcare decision-making.

References:

1. Leelahavarong P, Doungthipsirikul S, Kumluang S, Poonchai A, Kittiratchakool N, Chinnacom D, et al. HealthTechnology Assessment in Thailand: Institutionalization and Contribution toHealthcare Decision Making: Review of Literature. International journal of technology assessment in health care. 2019;35(6):467-73.

2. World Health Organization. Health Technology Assessment and Health Benefit Package Survey 2020/2021 Geneva, Switzerland: World Health Organization; 2020 [cited 2026 26 August]. Available from: https://www.who.int/teams/health-financing-and-economics/economic-analysis/health-technology-assessment-and-benefit-package-design/survey-homepage.

3. Guide to Economic Analysis and Research (GEAR). Guidelines Comparison. What can I learn from the existing health economic evaluation guidelines? Nonthaburi, Thailand: Guide to Economic Analysis and Research (GEAR) Online Resource; 2026 [cited 2026 26 August]. Available from: https://gear4health.com/gear/health-economic-evaluation-guidelines.

4. World Bank Group. Economies Washington DC, USA: World Bank Group; 2026 [cited 2026 25 August]. Available from: World Bank | Data 360

5. Health Intervention and Technology Assessment Program Foundation. Exploring the Acceptance of Private Sector-led Submissions (PLS) of Economic Evaluations in the NLEM Process Nonthaburi, Bangkok: Health Intervention and Technology Assessment Program Foundation; 2026 [cited 2026 25 August]. Available from: https://www.hitap.net/th/article/exploring-the-possibilities-of-accepting-economic-feasibility-studies-from-the-private-sector-in-the-process-of-developing-the-national-list-of-essential-medicines/.