INTEGRATING EQUITY INTO HTA VALUE ASSESSMENT IN EUROPE: A TARGETED LITERATURE REVIEW OF FRAMEWORKS, METHODS, AND POLICY APPLICATIONS ACROSS MAJOR HTA AGENCIES
Author(s)
Vinita Devjani, MBA1, Monica Verma, MPH2, Anand Jha, MBA3.
1Ansea Consultants Pte Ltd, Ahmedabad, India, 2Associate Director, Ansea Consultants Pte Ltd, Singapore, Singapore, 3Ansea Consultants Pte Ltd, Singapore, Singapore.
1Ansea Consultants Pte Ltd, Ahmedabad, India, 2Associate Director, Ansea Consultants Pte Ltd, Singapore, Singapore, 3Ansea Consultants Pte Ltd, Singapore, Singapore.
OBJECTIVES: To evaluate how equity is incorporated into health technology assessment and reimbursement decision-making across European health systems and identify methods and policy approaches used by HTA agencies.
METHODS: A targeted literature review was conducted across seven European HTA agencies (NICE, SMC, TLV, the Norwegian HTA system, HAS, IQWiG, and ZIN) using peer-reviewed journal articles, policy documents, and HTA agency reports published between 2016 and 2026. Evidence was reviewed to identify how equity considerations were incorporated into HTA processes and reimbursement decision-making. Findings were synthesized across agencies, focusing on ethical principles, severity and unmet need, health inequality considerations, and quantitative approaches to equity assessment.
RESULTS: The review identified substantial variation in how equity is incorporated across European HTA systems. NICE demonstrated the most advanced methodological development through consideration of disease severity, health inequalities, and emerging application of distributional cost-effectiveness analysis. Sweden and Norway incorporated equity through ethical and prioritization principles embedded in decision-making frameworks. Scotland and the Netherlands considered equity through severity, societal value, and prioritization criteria, while France and Germany primarily addressed equity through deliberative processes with limited methodological formalization. Across agencies, disease severity, unmet need, and reduction of inequalities emerged as the most frequently applied equity concepts. Four approaches to equity integration were identified: ethical prioritization frameworks, severity- and unmet need-based modifiers, health inequality assessment approaches, and deliberative appraisal processes. However, assessment of equity impacts and linkage of equity considerations to reimbursement outcomes remained uncommon.
CONCLUSIONS: Equity is increasingly recognized as part of value assessment within European HTA systems; however, substantial heterogeneity exists in its application. While several agencies have established mechanisms to incorporate equity considerations, most rely on qualitative deliberation rather than quantitative assessment. Greater methodological clarity is needed on when equity considerations alter reimbursement decisions, rather than being acknowledged only during deliberation.
METHODS: A targeted literature review was conducted across seven European HTA agencies (NICE, SMC, TLV, the Norwegian HTA system, HAS, IQWiG, and ZIN) using peer-reviewed journal articles, policy documents, and HTA agency reports published between 2016 and 2026. Evidence was reviewed to identify how equity considerations were incorporated into HTA processes and reimbursement decision-making. Findings were synthesized across agencies, focusing on ethical principles, severity and unmet need, health inequality considerations, and quantitative approaches to equity assessment.
RESULTS: The review identified substantial variation in how equity is incorporated across European HTA systems. NICE demonstrated the most advanced methodological development through consideration of disease severity, health inequalities, and emerging application of distributional cost-effectiveness analysis. Sweden and Norway incorporated equity through ethical and prioritization principles embedded in decision-making frameworks. Scotland and the Netherlands considered equity through severity, societal value, and prioritization criteria, while France and Germany primarily addressed equity through deliberative processes with limited methodological formalization. Across agencies, disease severity, unmet need, and reduction of inequalities emerged as the most frequently applied equity concepts. Four approaches to equity integration were identified: ethical prioritization frameworks, severity- and unmet need-based modifiers, health inequality assessment approaches, and deliberative appraisal processes. However, assessment of equity impacts and linkage of equity considerations to reimbursement outcomes remained uncommon.
CONCLUSIONS: Equity is increasingly recognized as part of value assessment within European HTA systems; however, substantial heterogeneity exists in its application. While several agencies have established mechanisms to incorporate equity considerations, most rely on qualitative deliberation rather than quantitative assessment. Greater methodological clarity is needed on when equity considerations alter reimbursement decisions, rather than being acknowledged only during deliberation.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA289
Topic
Economic Evaluation, Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes, Systems & Structure
Disease
No Additional Disease & Conditions/Specialized Treatment Areas