Global Health Panel Publishes New Recommendations for Assessing Health Technology in Multipayer Healthcare Systems

Published Aug 8, 2022

Report of an ISPOR Health Technology Assessment Council

Value in HealthLawrenceville, NJ, USA—August 8, 2022—Value in Health, the official journal of ISPOR—The Professional Society for Health Economics and Outcomes Research, announced today the publication of a new report examining the specific challenges of conducting and using health technology assessment in countries with multipayer healthcare systems. The report, “Challenges of Health Technology Assessment in Pluralistic Healthcare Systems: An ISPOR Council Report,” will be published in the August 2022 issue of Value in Health.

“Health technology assessment—HTA—has been growing in use over the last few years, especially in its impact on decisions concerning the reimbursement, adoption, and use of new drugs, devices, and procedures,” said author Michael F. Drummond, MCom, DPhil. “Yet much of the discussion of the use of HTA worldwide has concerned countries having a single payer for healthcare, such as a national health service or a national health insurance, as in several countries in northern Europe. This paper, conversely, reports on the research conducted by an ISPOR Health Technology Assessment Council established to examine the specific challenges of conducting and using HTA in countries with pluralistic healthcare systems.”

In pluralistic healthcare systems there are multiple payers or sectors, each of which could potentially benefit from HTA. However, a single HTA, conducted centrally, may not meet the needs of the different payers, who may have different budgets, different current standards of care, different populations to serve, or may be using different decision-making processes. If each payer organization conducts its own HTA, the resources for undertaking HTAs are likely to be more widely dispersed throughout the country and HTAs may be duplicated in more than one location. They may also be less rigorous, depending on whether the same level of resource and expertise typically available at the central level can also be made available locally.

ISPOR established a Health Technology Assessment Council Working Group to examine the specific challenges of conducting and using HTA in countries with pluralistic healthcare systems. The group used its own knowledge and expertise, supplemented by a narrative literature review and survey of US payers, to identify existing challenges and any initiatives taken to address them.

Ultimately, the working group proposed several general solutions grouped under 5 broad themes: (1) Establish a national focus for HTA; (2) Develop a uniform set of HTA methods guidelines; (3) Ensure that HTAs are produced in a timely fashion; (4) Facilitate the use of HTA in the local setting; and (5) Develop a framework to encourage transparency in HTA.

“While pluralistic healthcare systems pose several challenges for the conduct and use of health technology assessment, there is no fundamental reason why HTA cannot be successful in such systems,” said Drummond. “Most of these challenges can be addressed and we have made several recommendations for how this can be achieved. We hope that this provides the basis for the ISPOR Health Technology Council, other similar groups, and HTA stakeholders in countries with pluralistic systems to take matters forward by developing good practices for the conduct of HTA in pluralistic settings and initiating further training and research to help decision makers in local settings conduct or use HTAs.”


ISPOR, the professional society for health economics and outcomes research (HEOR), is an international, multistakeholder, nonprofit dedicated to advancing HEOR excellence to improve decision making for health globally. The Society is the leading source for scientific conferences, peer-reviewed and MEDLINE®-indexed publications, good practices guidance, education, collaboration, and tools/resources in the field.
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Value in Health (ISSN 1098-3015) is an international, indexed journal that publishes original research and health policy articles that advance the field of health economics and outcomes research to help healthcare leaders make evidence-based decisions. The journal’s 2021 impact factor score is 5.101 and its 5-year impact factor score is 6.747. Value in Health is ranked 5th of 87 journals in health policy and services, 7th of 102 journals in healthcare sciences and services, and 19th of 371 journals in economics. Value in Health is a monthly publication that circulates to more than 10,000 readers around the world.
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