Review of Health Technology Assessment Guidelines Worldwide

OBJECTIVES: Health Technology Assessment (HTA) is a multidisciplinary approach that synthesizes medical, social, economic, and ethical information on health technologies to inform decision-making. HTA guidelines ensure thorough, evidence-based evaluations of health technologies, reflecting best practices. This research analyses HTA guidelines globally, aiming to unveil diverse patterns which can be used to craft effective guidelines.

METHODS: A targeted non-systematic review was conducted on HTA guidelines through the Professional Society for Health Economics and Outcomes Research (ISPOR) website yielding a list of 54 guidelines. Key features were extracted: including assessment perspective; target population; choice of comparator; time horizon; preferred analytical method; sensitivity analysis; budget impact analysis requirement; etc.. Finally, a thematic analysis to organise and group the data was conducted followed by subgroup analysis by geographical regions and income levels.

RESULTS: Findings reveal that 61% of guidelines originate from high-income countries. The economic evaluation perspectives varied among guidelines, with 26% favouring a payer perspective. Cost-utility analysis was the most common approach, used in 33% of the guidelines. More than 50% preferred using effectiveness data rather than efficacy. The standard of care was selected as the comparator of choice in nearly half of the guidelines. A majority (74%) recommended a long-time horizon to capture all health benefits, with a discount rate for costs and benefits ranging from 3% and 5%. Over half of the guidelines recommended conducting sensitivity analysis on uncertain and key parameters using deterministic or probabilistic methods.

CONCLUSIONS: This global review reveals high similarity in HTA guidelines with fewer but influential differences across countries. With most guidelines originating from high-income countries, our results can act as a foundation for middle and low-income countries to develop their guidelines, considering economic and cultural variations.