MULTIDIMENSIONAL FOUNDATIONS FOR HTA ADOPTION IN DEVELOPING HEALTH SYSTEMS: A MENA REGIONAL EXPERT CONSENSUS ON GOVERNANCE, TRUST, AND CAPACITY BUILDING
Author(s)
Alaa Al Kashwan, PhD1, Abdulrazak Aljazairy, PhD2, Amal Yassine, Jr., BSc, MSc3, Anisa Rasool, BSc, MSc4, Asiya Ibrahim Juma AL Kindi, Sr., BSc, MSc5, Donald Husereau, BSc, MSc6, Hugh McGuire, BSc, MSc7, Jessica Davis, PhD8, Kawther Nassir, BSc, MSc1, Mohamed Farghaly, MD9, Qasim Alshara, BSc; MS10, Mahmoud M. Tolba, BSc, MSc11, Mohamed Seleem, BSc, MSc12, Mohamed Sherkhan, Sr., BSc, MSc13, Huda Jawad, Sr., BSc, MSc14, Nadia Al Mazrouei, PhD15, Qasim Alshara, Sr., BSc, MSc16, Sahar Fahmy, PhD17, Sahar Hassan, BSc, MSc18, Sara Mohibullah Al Balushi, III, BA19, Samar Mansour, PhD20, Mohamed Tannira, BSc, MSc20.
1National Committee for Drug Selection, Ministry of Health, Baghdad, Iraq, 2Clinical Trials Transformation Initiative Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 3Moroccan Society for Health Products Economy & ISPOR Maghreb Chapter, Mohammedia, Morocco, 4Ministry of Health, Muscat, Oman, 5Minsitry Of Health Oman, Muscat, Oman, 6Adjunct Professor, University of Ottawa, Ottawa, ON, Canada, 7National Institute of Health and Care Excellence, London, United Kingdom, 8National Institute for Health and Care Excellence (NICE), London, United Kingdom, 9Dubai Medical College, Dubai, United Arab Emirates, 10Bahrain Pharmacy & General Store W.L.L., Manama, Bahrain, 11Health Evidence & HEOR Department, Stellar Consulting MEA, Dubai, United Arab Emirates, 12National Committee of Drug Selection, Ministry of Health, Baghdad, Iraq, 13Pharmacoeconomic and market access expert, Baghdad, Iraq, 14University of Bahrain, Manama, Bahrain, 15Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates, 16Bahrain Pharmacy &General Store W.L.L., Manama, Bahrain, 17Department of Health, Abu Dhabi, United Arab Emirates, 18Health Evidence & HEOR Department, Stellar Consulting MEA, Dubai, United Arab Emirates, Dubai, United Arab Emirates, 19Directorate General of Medical Supplies-M.O.H, Jeddah, Saudi Arabia, 20ISPOR UAE Chapter, Dubai, United Arab Emirates.
1National Committee for Drug Selection, Ministry of Health, Baghdad, Iraq, 2Clinical Trials Transformation Initiative Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 3Moroccan Society for Health Products Economy & ISPOR Maghreb Chapter, Mohammedia, Morocco, 4Ministry of Health, Muscat, Oman, 5Minsitry Of Health Oman, Muscat, Oman, 6Adjunct Professor, University of Ottawa, Ottawa, ON, Canada, 7National Institute of Health and Care Excellence, London, United Kingdom, 8National Institute for Health and Care Excellence (NICE), London, United Kingdom, 9Dubai Medical College, Dubai, United Arab Emirates, 10Bahrain Pharmacy & General Store W.L.L., Manama, Bahrain, 11Health Evidence & HEOR Department, Stellar Consulting MEA, Dubai, United Arab Emirates, 12National Committee of Drug Selection, Ministry of Health, Baghdad, Iraq, 13Pharmacoeconomic and market access expert, Baghdad, Iraq, 14University of Bahrain, Manama, Bahrain, 15Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates, 16Bahrain Pharmacy &General Store W.L.L., Manama, Bahrain, 17Department of Health, Abu Dhabi, United Arab Emirates, 18Health Evidence & HEOR Department, Stellar Consulting MEA, Dubai, United Arab Emirates, Dubai, United Arab Emirates, 19Directorate General of Medical Supplies-M.O.H, Jeddah, Saudi Arabia, 20ISPOR UAE Chapter, Dubai, United Arab Emirates.
OBJECTIVES: To examine how HTA adoption in developing health systems extends beyond clinical-economic assessment to encompass governance architecture, institutional trust, regional collaboration, and phased capacity-building, with emphasis on contextual adaptation for MENA settings.
METHODS: A structured qualitative expert-consensus study was conducted, reporting per Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. A sample of 18 HTA leaders from regulatory (n=6), payer (n=3), academic (n=4), and international policy (n=5) sectors across MENA, UK and Canada participated. Consensus was determined via iterative polling (≥85% agreement on Likert-scale responses). Discussion focused on governance, trust-building, regional collaboration, operational challenges, managed entry agreements (MEAs), and capacity-building. Deliberations were analyzed using directed content analysis.
RESULTS: High consensus (100%) supported a phased implementation roadmap beginning with reimbursement-focused HTA. Trust was foundational through: (1) structured clinician participation, (2) formal patient engagement, and (3) transparent communication of HTA rationale. Regional collaboration through shared networks was prioritized by 85% of experts. Operational barriers, including interdepartmental fragmentation and personnel deficits, were identified by 100% of participants. Furthermore, 90% of experts identified collaborative MEAs as pragmatic tools for balancing innovative access with fiscal sustainability.
CONCLUSIONS: HTA effectiveness is contingent upon: (1) Governance: establishing ministerial-led units with standardized SOPs and review cycles; (2) Trust: cultivated through multi-stakeholder participation; and (3) Strategic Alignment: among health ministries, payers, clinicians, and civil society. Implementation Roadmap: (Year 1-2) Establish advisory committees and pilot reimbursement-focused HTA; (Year 3-5) Formalize institutionalization and launch MEA frameworks supported by ring-fenced budgets.
METHODS: A structured qualitative expert-consensus study was conducted, reporting per Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. A sample of 18 HTA leaders from regulatory (n=6), payer (n=3), academic (n=4), and international policy (n=5) sectors across MENA, UK and Canada participated. Consensus was determined via iterative polling (≥85% agreement on Likert-scale responses). Discussion focused on governance, trust-building, regional collaboration, operational challenges, managed entry agreements (MEAs), and capacity-building. Deliberations were analyzed using directed content analysis.
RESULTS: High consensus (100%) supported a phased implementation roadmap beginning with reimbursement-focused HTA. Trust was foundational through: (1) structured clinician participation, (2) formal patient engagement, and (3) transparent communication of HTA rationale. Regional collaboration through shared networks was prioritized by 85% of experts. Operational barriers, including interdepartmental fragmentation and personnel deficits, were identified by 100% of participants. Furthermore, 90% of experts identified collaborative MEAs as pragmatic tools for balancing innovative access with fiscal sustainability.
CONCLUSIONS: HTA effectiveness is contingent upon: (1) Governance: establishing ministerial-led units with standardized SOPs and review cycles; (2) Trust: cultivated through multi-stakeholder participation; and (3) Strategic Alignment: among health ministries, payers, clinicians, and civil society. Implementation Roadmap: (Year 1-2) Establish advisory committees and pilot reimbursement-focused HTA; (Year 3-5) Formalize institutionalization and launch MEA frameworks supported by ring-fenced budgets.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA405
Topic
Health Technology Assessment, Organizational Practices
Topic Subcategory
Systems & Structure
Disease
No Additional Disease & Conditions/Specialized Treatment Areas