OBJECTIVES: Since 2015 there has been substantial growth in multi-country collaborations across Europe, driven by the increasing number of expensive high-innovative drugs with medical need. By joining together, countries increase efficiency of their health technology assessment (HTA) processes to achieve greater bargaining power during price negotiations and ensure patients have timely access to affordable medications. BeNeLuxA brings together Austria, Belgium, Ireland, Luxembourg and The Netherlands, with a combined total population of 43 million. However, pharmaceutical companies are unlikely to enter into the joint processes without clarity of the assessment pathway including the methods and the decision criteria to be applied. Orphan medicinal products or advanced therapy medicinal products (ATMPs) for which market access in the individual countries is particularly challenging and time consuming, would benefit from a joint economic assessment.

METHODS: The aim of this study is to analyse existing HTA and reimbursement procedures within BeNeLuxA partner countries. The study highlights the differences in methodological approaches of the HTA submissions, decision criteria, and timelines to patient access. A comprehensive literature review was undertaken for all publications from 2015 to March 2022 using Medline, EMBASE, Central-Cochrane, Science Direct and PubMed databases.

RESULTS: The study identifies differences in perspective, cost-effectiveness-thresholds, discount rates for costs and outcomes, weight of clinical and economic criteria amongst the members of BeNeLuxA. HTA alignment occured between the core three BeNeLuxA countries (BE,NL,LUX) for three medicines: osimertinib, tafamidis, and telotristat ethyl.

CONCLUSIONS: The results of the study show that joint decision rules according to assessment and appraisal among BeNeLuxA countries would be more promising than its detailed unification of the national HTA methods.