Presentation (CTI)

OBJECTIVES: Recent initiatives by ISPOR, HTAi and international HTA bodies have emphasized the importance of health equity within value assessments. Despite this attention, there is limited understanding of how equity is operationalized within HTA processes. A review of HTA appraisals was conducted to examine how equity is explicitly considered across four major bodies (CDA-AMC, ICER, NICE, and PBAC).
METHODS: We conducted a review of 362 HTA appraisals published between January 2024 and April 2025. We extracted information on the presence of explicit equity considerations, their respective equity subgroup(s) and whether equity considerations were noted in final recommendations. We screened appraisals and supporting documents using PROGRESS-Plus equity keywords. Individuals from CDA-AMC, ICER, and NICE formed an informant panel who validated the approach and provided contextual insights into processes for their respective HTA bodies.
RESULTS: Overall, 241/362 (66.6%) appraisals explicitly referenced health equity. Most equity considerations were descriptive/qualitative in nature, with four using quantitative approaches to assess equity impact directly. Across all appraisals, equity considerations most commonly related to place of residence (37.7%), age (31.7%), and socioeconomic status (26.7%) (subgroups not mutually exclusive). Of the 66.6% appraisals explicitly referencing equity considerations, only 16% of reports explicitly mentioned equity in the phrasing of recommendations. Equity considerations appeared more likely to be explicitly incorporated into recommendation wording where technologies involved complex access barriers for underserved populations, or where equity was a key consideration in the deliberation. These findings were validated with the HTA group to better understand context and current work in this area.
CONCLUSIONS: Health equity is increasingly recognised in HTA. However, our study shows that there are opportunities to strengthen its systematic and transparent integration into decision-making. Clarifying the circumstances in which equity is considered, broadening available methodological approaches, and offering more explicit guidelines could support greater consistency of equity considerations in assessments and decision-making.