Presentation (CTI)

OBJECTIVES: To characterize RENETSA's networked HTA governance model, which produces coverage recommendations applicable to independently financed public subsystems in Peru (2020-2026).
METHODS: Descriptive analysis of two sources: (1) the normative documents and methodological manuals that established the network and its deliberative process, and (2) the complete corpus of oncology multicriteria HTA assessments published by RENETSA (n=125, 2023-2025; the only operational line so far).
RESULTS: Peru's public health system covers ~90% of the population through independently financed subsystems (the contributory insurer, the subsidized insurer, and the armed-forces and police schemes) that historically incorporated innovations separately, generating cross-system coverage disparities. RENETSA, established in 2020 and led by the National Institute of Health, introduced a shared deliberative process: producing agencies prepare a technical report that feeds a deliberation with representatives from all subsystems and clinical specialists (patient representatives since late 2025); recommendations apply to all subsystems regardless of who submitted the request. It covers only high-cost technologies above a national annual-cost threshold (≈USD 11,000-12,000); other technologies follow the prior national formulary processes. This architecture stems from the cancer and rare-disease laws. Between 2023 and 2025, RENETSA produced 106 multicriteria oncology assessents (17 to 46 annually; 71% against) and, under a transitional provision of the cancer law, homologated 19 technologies previously approved by IETSI (2016-2021), retroactively extending its cross-system scope to coverage decisions inherited from a single subsystem. The methodology evolved from a ten-criterion Evidence-to-Decision framework to a three-domain structure (therapeutic, economic, social) with conditional recommendations.
CONCLUSIONS: RENETSA's core contribution is structural: a single deliberative process produces recommendations for independently financed subsystems, replacing fragmented formulary-based decisions. It is a rarely documented networked HTA governance model for segmented health systems, suggesting replicable conditions for countries seeking to consolidate HTA capacity without unifying financing.