Impact of Health Technology Assessment Bodies on Health System Outcomes in Low-and-Middle-Income Countries

OBJECTIVES: This study aims to assess the impact of government-operated Health Technology Assessment Bodies (HTAs) on healthcare spending changes and health outcomes.

METHODS: The initial sample comprised low- and middle-income countries (LMICs). HTA presence was identified using the WHO’s 2021 Global Survey on HTA and Health Benefit Packages, supplemented by a literature review and Google search. The treatment group consisted of countries identified to have an HTA presence. We excluded countries with no clear year of HTA implementation or with non-governmental HTAs. Dependent variables included out-of-pocket (OOP) expenditures, current health expenditure, mortality from chronic conditions, and average life expectancy. We controlled for country-level covariates including population size, gender, GDP, Gini index, and percentage of population over 65. Data sourced from the World Health Organization, Health Nutrition and Population Statistics database, and World Bank were used for outcomes and covariates and were averaged over 5 years to address missing data. Staggered difference-in-differences models were employed, with control group treatment years randomly assigned based on the distribution of treatment years in the treated group.

RESULTS: The study included 69 countries in the control group and 28 in the treatment group. Most countries established an HTA body between 2015 and 2020. The introduction of HTA led to a non-significant increase in monthly/annual OOP spending ($28.69 per month???) and a non-significant increase in life expectancy (0.22 years). HTA introduction also resulted in a non-significant decrease in mortality from chronic conditions (-0.69%) and a non-significant decrease in current health expenditure by 0.45%. Variations in results were observed based on the year of HTA introduction, with more favorable outcomes noted in subsequent years.

CONCLUSIONS: The introduction of HTA in LMICs did not yield significant changes in the explored outcomes. Future research should focus on non-proxy outcomes and aim to mitigate data gaps to further investigate this topic.