Integrating Health Equity Into Health Technology Assessment: A Scoping Review
Author(s)
Anton Avanceña, PhD1, Antonio Ahumada-Canale, PhD2, Chinyere Mma Okoh, PhD3, Haneen AlJamal, MSc4, Ramiro Eugenio Gilardino, MHA, MSc, MD5, Rajshree Pandey, MPH, PhD6.
1The University of Texas at Austin, Austin, TX, USA, 2CHERE UTS, Sydney, Australia, 3University of Texas at Austin, Austin, TX, USA, 4MSc Student, Queen Mary University of London, London, United Kingdom, 5University of Buenos Aires, Buenos Aires, Argentina, 6Alexion AstraZeneca Rare Disease, Boston, MA, USA.
1The University of Texas at Austin, Austin, TX, USA, 2CHERE UTS, Sydney, Australia, 3University of Texas at Austin, Austin, TX, USA, 4MSc Student, Queen Mary University of London, London, United Kingdom, 5University of Buenos Aires, Buenos Aires, Argentina, 6Alexion AstraZeneca Rare Disease, Boston, MA, USA.
OBJECTIVES: This scoping review explores how equity is defined and integrated in Health Technology Assessments (HTA), identifying barriers and facilitators for implementation. Conducted under Health Equity Research Special Interest Group, it is one of the first global syntheses on this topic. Findings will inform the development of a survey for HTA stakeholders on equity considerations.
METHODS: Following PRISMA-ScR guidelines, we conducted a structured search for published literature on Embase and PubMed (2014-2024) and grey literature (2019-2024). Studies reporting on health equity definitions, methods, data gaps, barriers, and facilitators of implementation within HTA processes were included. Two researchers independently screened literature for eligibility using automation in the Nested Knowledge platform.
RESULTS: Of 919 studies identified, 25 studies met inclusion criteria. Health equity was often defined as “the absence of unfair and avoidable differences in health status across populations”. Reports from NICE, SBU, CADTH, and HIQA noted use of deliberative processes to address equity. While three studies recommended including multi-criteria decision analysis or mixed methods to enhance transparency and consistency, one warned that relying solely on the deliberative process may delay the standardization of quantitative approaches. The importance of societal perspectives was also emphasized. Key barriers to implementation include economic constraints, lack of standardized guidance, regulatory challenges, non-inclusive stakeholder engagement, and insufficient data. Data gaps include context-specific data, information on social determinants of health, and opportunity costs. Real world data was noted as useful but underutilized due to challenges in collection, interpretation, and integration. Facilitators include collaborations between HTA and regulatory agencies, standardizing equity assessment frameworks, incentives, and enhancing clinical trial diversity.
CONCLUSIONS: This review underscores the need for standardized and inclusive methods and informs an ongoing international stakeholder survey to validate and expand identified barriers and facilitators. The project aims to support consensus-building and actionable strategies for more equitable HTA practices.
METHODS: Following PRISMA-ScR guidelines, we conducted a structured search for published literature on Embase and PubMed (2014-2024) and grey literature (2019-2024). Studies reporting on health equity definitions, methods, data gaps, barriers, and facilitators of implementation within HTA processes were included. Two researchers independently screened literature for eligibility using automation in the Nested Knowledge platform.
RESULTS: Of 919 studies identified, 25 studies met inclusion criteria. Health equity was often defined as “the absence of unfair and avoidable differences in health status across populations”. Reports from NICE, SBU, CADTH, and HIQA noted use of deliberative processes to address equity. While three studies recommended including multi-criteria decision analysis or mixed methods to enhance transparency and consistency, one warned that relying solely on the deliberative process may delay the standardization of quantitative approaches. The importance of societal perspectives was also emphasized. Key barriers to implementation include economic constraints, lack of standardized guidance, regulatory challenges, non-inclusive stakeholder engagement, and insufficient data. Data gaps include context-specific data, information on social determinants of health, and opportunity costs. Real world data was noted as useful but underutilized due to challenges in collection, interpretation, and integration. Facilitators include collaborations between HTA and regulatory agencies, standardizing equity assessment frameworks, incentives, and enhancing clinical trial diversity.
CONCLUSIONS: This review underscores the need for standardized and inclusive methods and informs an ongoing international stakeholder survey to validate and expand identified barriers and facilitators. The project aims to support consensus-building and actionable strategies for more equitable HTA practices.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA205
Topic
Health Technology Assessment, Organizational Practices
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas