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Today, global health systems are increasingly depending on Health Technology Assessment (HTA) to guide them in decisions on adopting new medical interventions, devices, and policies. Health Technology Assessment is the multidisciplinary, evidence-based process that evaluates the clinical effectiveness, economic cost-effectiveness, social, ethical, and organizational implications of health technologies (1). HTA aims to assist policy makers by providing evidence for decision-making and developing guidance on the reimbursement and administration of new health technologies within a national healthcare system. Health technologies include pharmaceuticals, medical equipment used in diagnosing and treatment, prevention, or treating diseases, improving rehabilitation, and providing long-term care (2).
Some organizations, like the WHO, support HTA as a key tool for achieving equitable, efficient, and sustainable health systems. Through global surveys and guidance material, WHO supports countries, particularly low and middle-income countries, in strengthening national capacity building, international networking and collaboration in health intervention and technology assessment to support evidence-based health policy (3).
All four countries, such as Australia, Canada, England, and Scotland, have effectively incorporated assessments into a national reimbursement recommendation that is guided by both clinical efficacy and cost-effectiveness and have a framework that includes patient input. The National Institute for Care and Health Excellence (NICE) in the UK is a widely recognized national HTA body. The Canadian Agency for Drugs and Technologies in Health (CADTH) play a central role in health technology assessment in Canada. The Canada Drug Agency (CDA-AMC) methods guide for HTA was recently updated in 2025, showing continuing institutionalisation and methodological sophistication (4) (5).
However, despite its benefits, global adoption remains uneven, particularly in low- and middle-income countries of the world. Barriers to HTA utilization include a lack of awareness and institutionalisation, whereas the top barriers to HTA production are a lack of budgets, data, and human resources. These barriers can be mitigated only with concerted and adequate resources (6).
References:
- (2021, September 2). Health technology assessment - Global. Who.int; World Health Organization: WHO. //www.who.int/health-topics/health-technology-assessment#tab=tab_1
- Joore, M., Grimm, S., Annelies Boonen, Wit, M. de, Guillemin, F., & Fautrel, B. (2020). Health technology assessment: a framework. RMD Open, 6(3), e001289–e001289. //doi.org/10.1136/rmdopen-2020-001289
- Providing guidance to countries on Institutionalizing Health technology assessment. (2021). Who.int. //www.who.int/activities/providing-guidance-to-countries-on-institutionalizing-health-technology-assessment
- Allen, N., Walker, S. R., Liberti, L., & Salek, S. (2016). Health Technology Assessment (HTA) Case Studies: Factors Influencing Divergent HTA Reimbursement Recommendations in Australia, Canada, England, and Scotland. Value in Health, 20(3), 320–328. //doi.org/10.1016/j.jval.2016.10.014
- Methods Guide for Health Technology Assessment March 2025. (n.d.). //www.cda-amc.ca/sites/default/files/MG%20Methods/MG0030-Quantitative-Methods-Manual_Mar%202025.pdf
- Mirelman, A. J., Goel, K., & Edejer, T. T.-T. (2025). The global landscape of country-level health technology assessment processes: A survey among 104 countries. Health Policy OPEN, 8, 100138. //doi.org/10.1016/j.hpopen.2025.100138
Posted : December 6, 2025 8:55 pm
To make progress towards universal health coverage (UHC), countries need to be able to develop and implement evidence-informed, legitimate, and inclusive processes for decision-making that can inform what services are provided and purchased, and at what price. Health decision-makers face tough choices when deciding amongst the numerous available interventions to cover to meet the health needs of their populations and balance multiple health system objectives such as fairness and efficiency. Each decision also has an implication on what can be covered elsewhere in the system; that is, it has an opportunity cost.
To support health decision-making, Health Technology Assessment (HTA) processes have existed for several decades and as an established mechanism for evidence-informed priority setting in the health sector, and it has even been included in multiple WHO resolutions such as WHA 67.23 in 2014. HTA is defined as, “a multidisciplinary process that uses explicit methods to determine the value of a health technology at different points in its lifecycle. The purpose is to inform decision-making in order to promote an equitable, efficient, and high-quality health system.” [2]. The term “health technology” is defined broadly as any health service or intervention. HTA can be applied to many decision-making scenarios such as whether to include a new medicine into a health coverage scheme, rolling-out broad public health programs (such as immunization or cancer screening), informing pricing for medicines, and formulating clinical guidelines.
Despite commonalities, HTA processes vary significantly from country to country. There have been several efforts to understand the status of HTA in countries around the world, including information on the institutional arrangement, processes, and barriers. In Asia, there have been studies to understand the landscape of HTA systems and practices, which find that processes are implemented differently and that there is often a lack of adequate resources. In Europe, the variation in practice and barriers to production and use of HTA has been explored in more depth through the EUnetHTA project and in groups of countries such as Central, Eastern, and South-Eastern Europe (CESEE) countries, non-European Union (EU) countries, and the Balkan countries. For Latin America and the Caribbean region, a survey of 30 countries found that despite much development in the area of HTA, the uptake of formal processes in the region remained relatively low. In the Middle East region, HTA is still relatively new, and a survey of countries showed that there is demand for further institutionalization. In a survey across low- and middle-income countries, a landscape assessment of HTA concluded that while HTA practices were growing in low- and middle-income countries, there are critical gaps in incorporating the recommendations from HTA into policy. Finally, in a survey of 27 established HTA agencies around the world, it was found that while there was relatively well-established guidance for assessment, other areas of governance, appraisal and monitoring lacked definitive guidance.
HTA development around the world requires that processes are institutionalized in a manner that is robust and sustainable. A WHO framework on how to institutionalize HTA features a five-part framework that includes: 1) establishing a mandate, 2) establishing a legal framework, 3) establishing institutional arrangements, 4) procedural aspects of assessment and appraisal, and 5) monitoring and evaluation of the HTA mechanism. To assess the practice of HTA in countries, the WHO conducted a global survey in 2020 and 2021 that builds on this framework and explores the status of HTA. To our knowledge, the survey is the largest source of information in terms of number of countries included for describing the global status of HTA. Using the institutionalization framework, the objective of this paper is to show the results from the survey in order to understand the current landscape of HTA practice.
References
World Health, O., SIXTY-SEVENTH WORLD HEALTH ASSEMBLY, in RESOLUTIONS AND DECISIONS. 2014: Geneva.
O’Rourke B, Oortwijn W, Schuller T. The new definition of health technology assessment: A milestone in international collaboration. Int J Technol Assess Health Care 2020;36(3):187–90.
Bertram, M., et al., Institutionalizing health technology assessment mechanisms: a how to guide. 2021.
Teerawattananon Y, et al. Landscape analysis of health technology assessment (HTA): systems and practices in Asia. Int J Technol Assess Health Care 2019;35(6): 416–21.
Sharma M, et al. A landscape analysis of health technology assessment capacity in the Association of South-East Asian Nations region. Health Res Policy Syst 2021;19 (1):1–13.
Willemsen A, et al. EUnetHTA relative effectiveness assessments: efforts to increase usability, transparency and inclusiveness. Int J Technol Assess Health Care 2022;38 (1):e41.
García-Mochon ´ L, et al. HTA and decision-making processes in Central, Eastern and South Eastern Europe: Results from a survey. Health Policy 2019;123(2):182–90.
Ciani O, et al. Health technology assessment of medical devices: a survey of nonEuropean union agencies. Int J Technol Assess Health Care 2015;31(3):154–65.
Organization, W.H., Current status of health intervention and technology assessment in the Balkan region. 2020, World Health Organization. Regional Office for Europe.
Lessa F, et al. Strengthening and implementing health technology assessment and the decision-making process in the Region of the Americas. Revista Panamericana de Salud Pública 2018;41:e165.
Fasseeh A, et al. Implementation of health technology assessment in the Middle East and North Africa: comparison between the current and preferred status. Front Pharmacol 2020;11:15.
Babigumira JB, et al. Health technology assessment in low-and middle-income countries: a landscape assessment. J Pharm Health Serv Res 2016;7(1):37–42.
Oortwijn W, Jansen M, Baltussen R. Use of evidence-informed deliberative processes by health technology assessment agencies around the globe. Int J Health Policy Manag 2020;9(1):27
Posted : December 16, 2025 11:19 am