OBJECTIVES: Health inequality refers to differences in health statuses/outcomes among people. Health inequity occurs due to unjust and systematic factors. Both relate to reduced development and social justice. Health Technology Assessment (HTA) has been recognized as a potential means to reduce health inequality/inequity. This research aimed to identify HTA appraisal frameworks of high-income/middle-income countries (HICs/MICs) to assess whether considerations of health equality/equity are included as core principles of the HTA decision-making.

METHODS: We selected 5 Western Europe, 5 Northern Europe, 5 LatAm and 5 Asian countries with established formal HTA entities. We reviewed the HTA appraisal frameworks used in these countries and identified those in which equality/equity were considered in the decision-making criteria. Subsequently, we reviewed initiatives by the Institute for Clinical and Economic Review (ICER) and the Centers of Medicare & Medicaid Services (CMS) in the USA aiming to improve equality/equity.

RESULTS: We found that HTA agencies in HICs/MICs are slowly advancing towards equality/equity goals. Out of the HTA entities identified, only 8 have established equality/equity as part of the decision-making criteria. Most (62.5%) were in the Northern European region. Among these 8 HTA entities, equality/equity criteria were mostly (75.0%) observed during the prioritization stage of the HTA process. Subsequently, we found that, in the USA, ICER announced an initiative to evaluate potential methodology changes to advance health equity goals. The findings of this initiative will be used to update ICER’s value assessment framework. Additionally, the CMS is launching the Enhancing Oncology Model to improve health equity.

CONCLUSIONS: HTA entities are moving towards equality/equity-based policies through considerations on how equality/equity is impacted by new technologies and how are special sub-populations differently affected. The extent to which these efforts translate into improved health equality/equity remains uncertain, and more research using inequality/inequity indexes is needed to evaluate impact.