Presentation (CTI)

OBJECTIVES: Health equity is recognised as essential in HTA, yet countries vary in formally integrating equity into economic evaluations. Although numerous methodological tools, like equity weights, DCEA, proportional and absolute shortfall, ECEA, SWFs, MCDA, and equity impact assessments, have been suggested, their practical inclusion in HTA guidance is inconsistent. This study examines how the EU4 and the Netherlands HTA agencies incorporate health equity into official economic evaluation frameworks.
METHODS: A targeted review was conducted. All methodological manuals and policy updates published between 2020 and 2025 were identified for HAS (France), IQWiG (Germany), ZIN (Netherlands), AIFA (Italy), and AETS (Spain). Data were extracted by a single reviewer against pre-specified inclusion criteria relating to the health equity methodologies.
RESULTS: The most recent methodological manuals were identified. HAS and AIFA HTA guidelines were published in 2020, ZIN and AETS published in 2024 and draft IQWiG guidelines presented in 2025 (update of 2023 guidelines). ZIN explicitly uses proportional shortfall to adjust willingness-to-pay thresholds based on the severity of a condition with updated guidelines recommend including HRQoL impact on informal caregivers in economic evaluation through the EQ-5D-5L. In addition, MCDA may be used in specific cases, however, is not part of their core framework. AETS guidance recognises equity as a qualitative criterion within decision-making, emphasising social value and ethical distribution, with no formal quantitative tools. HAS, IQWiG, and AIFA do not formally incorporate health equity methodologies in HTA guidance with the focus on other aspects such as clinical benefit, patient-centered outcomes, cost-effectiveness, and budget impact.
CONCLUSIONS: Formal integration of equity into economic evaluations remains limited. Only ZIN applies quantitative methodology, while AETS recommends qualitative equity consideration. HAS, IQWiG, and AIFA offer no formal guidance for health equity methodology. This underscores a fragmented European landscape and suggest the need for shared equity methodologies to promote fairer HTA decision-making.