Presentation (CTI)

OBJECTIVES: The European Union (EU) Health Technology Assessment Regulation (HTAR) promotes collaboration across Member States (MS) and capacity building of national health technology assessment (HTA) systems alongside Joint Clinical Assessments (JCA). This study explored participation and role allocation patterns, reviewed implementation and barriers, and national approaches to integrating JCA outputs to generate insights into HTAR implementation and capacity-building.
METHODS: A targeted review of EU HTAR policy documents and published literature was conducted to identify participation patterns, capacity considerations and implementation challenges at national and EU levels. National approaches to incorporating JCA findings into HTA processes were extracted. Publicly available data on JCAs through June 2026 were analyzed, and participation patterns were interpreted alongside literature findings.
RESULTS: Eighteen JCAs were identified, with assessor roles concentrated across 9 MS. Germany led 6 JCAs (33%) while other MS led 1 to 2 JCAs (6-11%). Co‑assessor roles were distributed across 14 MS, each contributing to 1 to 2 JCAs (6-11%). Central and Eastern European MS participated exclusively as co‑assessors in 4 JCAs (22%). Overall participation was highest for Germany (44%) and France (22%). Participation broadened over time, through MS joining as co-assessors, without recurring pairings. National-level studies (n=5) highlighted limited resources, skills gaps, and challenges integrating JCAs into national processes potentially limiting participation. Evidence suggests variation in how MS are adapting national HTA processes to accommodate JCA outputs. European-level studies (n=30) identified structural barriers, including capacity constraints, methodological complexity, heterogeneity in HTA maturity, coordination challenges, duplication , and timeline pressures.
CONCLUSIONS: Early JCA participation patterns suggest a hub‑and‑spoke structure, with a core group leading assessments and broader participation in supporting roles. Structural and methodological constraints may limit participation across more MS. Variation in national implementation may influence how JCA evidence is used in decision-making. Participation dynamics may shape evidence expectations and inform national‑level decision‑making.