Diverse structures and methods of national health technology assessment organizations: A scoping review

Objectives

To explore the structure and methods of health technology assessment (HTA) organizations.

Methods

We included organizations that conduct HTA to inform coverage/reimbursement decisions nationally in any country. Eligible organizations were identified through a systematic search of well-known HTA networks (International Network for Agencies for HTA [INAHTA], European Network for Health Technology Assessment [EUnetHTA], Red de Evaluación de Tecnologías en Salud de las Americas [RedETSA], HTAsiaLink) and references from previous studies evaluating HTA organizations.

Results

We identified 69 organizations, from 56 countries. Most organizations are European (n = 39, 56 %) and governmental (n = 53, 77 %). Fifty-one (74 %) advise health authorities, while 13 (19 %) are the ultimate decision-making authority. Of 62 organizations with known funding, all use public resources, and 12 (17 %) charge a fee for evaluation. Healthcare technologies evaluated are medicines (n = 61, 88 %), devices (n = 47, 68 %), and procedures (n = 33, 48 %). Sixty-six organizations (96 %) consider economic factors, with cost-effectiveness and budget impact analyses being the most conducted evaluations. HTA is usually initiated upon the manufacturer's request (n = 45, 65 %). Patient involvement is not clearly described in 32 organizations (46 %), and 2 (3 %) report no involvement; among the remaining, for most (n = 29, 42 %), the role of patients is to provide information to be considered during the decision-making process.

Conclusions

Our results underscore the diverse landscape of HTA organizations, highlighting both shared methodologies and unique adaptations, a knowledge that is valuable for countries looking to establish or refine their HTA organizations.

Lay summary

Health technology assessment (HTA) is crucial for guiding healthcare decisions and policies around the world. We analyzed 69 organizations from 56 countries that use HTA to inform national coverage and reimbursement decisions. These organizations, primarily government-affiliated, advise on which healthcare technologies—like medications and medical devices—should be funded based mainly on their effectiveness and cost. Despite their common goals, we found significant variation in how they operate, especially in the criteria they use to make recommendations and how they involve stakeholders. Understanding these global practices helps countries improving their own HTA processes, ensuring better healthcare outcomes.