Presentation (CTI)

OBJECTIVES: To describe the distribution, evidence base, and argument types of the equity criterion in oncology multicriteria health technology assessments (ETS-EMC) by RENETSA/INS, Peru (2023-2025).
METHODS: Structured content analysis of 105 oncology ETS-EMC that applied the multicriteria Evidence-to-Decision (EtD) framework with an equity criterion (2023-2025). In each, a deliberative working group issues structured judgments on nine of its ten criteria, including health equity (disease burden is referential). The governing 2022 Technical Document prescribed assessing differential impact on disadvantaged groups via PROGRESS-Plus and a systematic search for empirical evidence. Equity judgments were verified by direct reading; argument types were classified with a 12-category inductive taxonomy via LLM-assisted coding with human verification.
RESULTS: All 105 documents contained a structured equity judgment; none cited empirical evidence on differential impact (98% referenced no external source), and all judgments arose from deliberation. Uncertain judgments ("don't know") were most frequent (42%), followed by positive (35%), neutral (16%), subgroup disagreement (4%), and negative (3%). The distribution was biphasic: positive judgments dominated in 2023 (72%), while uncertainty became dominant in 2024-2025 (46% and 54%). Positive judgments were more frequent among documents with a favorable recommendation (65% vs. 5%). PROGRESS-Plus in methods rose from 0% (2023) to 41% (2025), but none applied it dimensionally.
CONCLUSIONS: What the 2022 Technical Document prescribed did not materialize: the equity criterion is operationally present but empirically empty. Its dominant judgment evolved from positive access-proxy inference (2023) to declared uncertainty (2024-2025), suggesting a formalization paradox in which more deliberative structure coincided with greater declared uncertainty rather than its resolution. When defined, the judgment rested on access as a proxy, not on differential distribution among disadvantaged groups. To our knowledge, this is the first document-level evidence on the equity criterion across all multicriteria assessments of a national HTA agency in a middle-income Latin American country.