FROM VOICE TO VALUE: A SYSTEMATIC REVIEW AND CONCEPTUAL FRAMEWORK OF PATIENT ENGAGEMENT IN HEALTH TECHNOLOGY ASSESSMENT
Author(s)
TAL MORGINSTIN, B. Pharm, M.Sc., Ph.D.1, Dan Greenberg, BA, MSc, PhD2, Segev Shani, B. Pharm, MHA, MBA, LLB, LLM, Ph.D.3.
1Faculty of Health Sciences, Department of Health Policy & Management, School of Public Health, Ben Gurion University of the Negev, Beer-Sheva, Israel, 2Faculty of Health Sciences, Department of Health Policy & Management, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 3Faculty of Health Sciences, Department of Health Policy & Management, School of Public Health, Ben Gurion University of the Negev, Beer Sheva, Israel.
1Faculty of Health Sciences, Department of Health Policy & Management, School of Public Health, Ben Gurion University of the Negev, Beer-Sheva, Israel, 2Faculty of Health Sciences, Department of Health Policy & Management, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 3Faculty of Health Sciences, Department of Health Policy & Management, School of Public Health, Ben Gurion University of the Negev, Beer Sheva, Israel.
OBJECTIVES: Patient and public involvement (PPI) is increasingly recognized as a key component of health technology assessment (HTA), enhancing the legitimacy, transparency, and relevance of healthcare decision-making. Despite growing adoption worldwide, PPI remains heterogeneous with limited understanding of how different engagement approaches relate to HTA processes. This study systematically reviewed international experiences of PPI in HTA and develop a conceptual framework for categorizing engagement approaches according to their role and influence in HTA processes and decision-making.
METHODS: A systematic review was conducted following PRISMA guidelines. Literature search in PubMed, CINAHL, Cochrane Library, OVID, ProQuest and SciVerse Hub, and supplemented by reference screening, grey literature searches, and consultation with HTA agencies, identified studies published between 1988-2023. Data were extracted on engagement mechanisms, participants, involvement stages, and barriers and facilitators. Findings were synthesized thematically to identify recurring engagement patterns.
RESULTS: The review identified 5975 records, of which 57 publications met the inclusion criteria. Expert discussions and reference follow-up yielded 95 additional publications, resulting in 152 publications representing 148 distinct studies.
Four conceptual models of patient engagement emerged: Consultation, Evidence Contribution, Deliberative Participation, and Partnership. These represent a continuum of increasing integration and influence within HTA processes. Consultation, the most common model, involved advisory input through submissions and public consultations. Evidence contribution incorporated patient-reported outcomes, preferences, and experiential evidence. Deliberative participation included patient representation in advisory and appraisal committees. Partnership reflected shared governance and co-design of HTA processes. Each model was associated with distinct participant roles, knowledge contributions, institutional requirements, and implementation challenges.
CONCLUSIONS: PPI in HTA is best understood as a continuum rather than a single practice. Advancing toward more influential forms of engagement requires dedicated participation mechanisms, institutional capacity, governance structures, and organizational commitment. The proposed framework provides HTA agencies with a practical tool for evaluating practices and designing context-appropriate strategies to strengthen meaningful PPI.
METHODS: A systematic review was conducted following PRISMA guidelines. Literature search in PubMed, CINAHL, Cochrane Library, OVID, ProQuest and SciVerse Hub, and supplemented by reference screening, grey literature searches, and consultation with HTA agencies, identified studies published between 1988-2023. Data were extracted on engagement mechanisms, participants, involvement stages, and barriers and facilitators. Findings were synthesized thematically to identify recurring engagement patterns.
RESULTS: The review identified 5975 records, of which 57 publications met the inclusion criteria. Expert discussions and reference follow-up yielded 95 additional publications, resulting in 152 publications representing 148 distinct studies.
Four conceptual models of patient engagement emerged: Consultation, Evidence Contribution, Deliberative Participation, and Partnership. These represent a continuum of increasing integration and influence within HTA processes. Consultation, the most common model, involved advisory input through submissions and public consultations. Evidence contribution incorporated patient-reported outcomes, preferences, and experiential evidence. Deliberative participation included patient representation in advisory and appraisal committees. Partnership reflected shared governance and co-design of HTA processes. Each model was associated with distinct participant roles, knowledge contributions, institutional requirements, and implementation challenges.
CONCLUSIONS: PPI in HTA is best understood as a continuum rather than a single practice. Advancing toward more influential forms of engagement requires dedicated participation mechanisms, institutional capacity, governance structures, and organizational commitment. The proposed framework provides HTA agencies with a practical tool for evaluating practices and designing context-appropriate strategies to strengthen meaningful PPI.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA325
Topic
Health Policy & Regulatory, Health Technology Assessment, Patient-Centered Research
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas