OBJECTIVES: In 2014 the resolution 67.23 of the World Health Assembly urged the member states to consider establishing HTA processes in support of universal healthcare. WHO released a 2015 and 2021 report on global HTA. This research reviews the implementation of HTA processes across the largest markets in each region and identify countries that use cost-effectiveness (CE) assessment mechanisms.

METHODS: Top five healthcare markets by size were identified in the following regions (Americas, Europe, APAC, Rest of the world). The 2021 WHO Global Survey on HTA and Health Benefit Packages report was used as a starting point to identify the countries with established HTA process, the availability of national guidelines for the preparation of economic evaluation and whether CEA was used for decision making for reimbursement. Any missing information was addressed through targeted literature review.

RESULTS: 13% increase response rate to WHO survey from 2011 to 2021 (111 to 125 countries). In 2021, 95% (19 of 20) of markets have established an HTA process to support healthcare decision-making. 79% of the countries with HTA (15 of 19) have established national guidelines for the economic evaluation assessment. 74% of the countries with HTA (14 of 19) use CEA in healthcare decision making, but only United Kingdom publicly defines the CE threshold use for medicines reimbursement decisions.

CONCLUSIONS: Interest in HTA by global markets increased between 2015 and 2021. Majority of largest healthcare markets by region have already implemented HTA processes to support decision-making in healthcare. CEA are very common in HTAs, with over 70% of the largest markets using them. Future research needed to understand the progression of HTA implementation across global markets, and the level of influence established CEA HTAs have on the newly developed HTAs processes on other global markets.