OBJECTIVES: Health technology assessment (HTA) is used internationally to establish whether new interventions represent an efficient allocation of scarce healthcare resources. However, reimbursement decisions are often inconsistent between countries likely due to differences in HTA frameworks adopted and wider political and socio-economic factors. The objective of this study was to investigate the relationships between different health-system factors and the likelihood of a successful HTA outcome across several countries.

METHODS: HTA recommendations published in 2023 across 10 countries (England, Scotland, France, Denmark, Spain, Ireland, Netherlands, Sweden, Australia, and Canada) were reviewed, and data were collated describing the total number of appraisals, and the number resulting in positive reimbursement recommendations. Health-systems data was also collected for each country, including healthcare expenditure (as a proportion of GDP), healthcare funding source (primarily social insurance or tax-financed), pharmaceutical pricing policy, and HTA processes such as cost-effectiveness and patient-group involvement. Univariate meta-regression models were used to examine associations between each of the health-systems factors and positive reimbursement recommendations.

RESULTS: In total, 783 HTA appraisals were conducted across the 10 countries in 2023, of which 527 (67%) received a positive reimbursement decision. Substantial differences in reimbursement decisions were observed between countries, with Ireland having the lowest proportion of positive reimbursement recommendations (7%) and France having the highest (88%). The meta-regression analysis indicated that healthcare expenditure was a statistically significant predictor of reimbursement success rate (p<0.001), whereby countries with greater healthcare expenditure are more likely to reimburse new products. Countries where healthcare is predominantly funded through taxation, whose HTA framework includes cost-effectiveness assessment, and who do not operate a free pricing model were nominally less likely to issue positive recommendations.

CONCLUSIONS: Significant heterogeneity was observed in the reimbursement success rates between the countries included in the analysis. In general, countries with higher healthcare expenditure more frequently recommend new products for reimbursement.