OBJECTIVES : Patient participation in national reimbursement or Health Technology Assessment (HTA) processes has been increasingly gaining traction. Patients can provide their perspectives from the disease experience into the evaluation process, alongside providing more credibility to payer decisions through their inclusion. This research aimed to compare patient engagement in HTA across countries to inform a discussion on their optimal level of involvement.

METHODS : A targeted literature review and internal expert validation was undertaken in 20 countries across Europe, Asia-Pacific, and the Americas in order to understand the extent of patient involvement in HTA decisions.

RESULTS : Out of 20 countries included in this research, only 4 (20%) were found to not engage patients in HTA decisions (China, Japan, Vietnam and Mexico). Out of countries that involve patients directly in the HTA process (13; 65%), nearly all (12; 92%) were found to have a process of engaging patients as part of the HTA committee meeting but only half (6/12) offered a platform for patients to feedback on the preliminary assessment. The remaining 3 (3/20; 15%) countries in this analysis were involving patients outside of their HTA process in a broader engagement with health authorities that would eventually impact reimbursement.

CONCLUSIONS : Many countries involve patients in their decision-making process, however their involvement is typically limited. Countries which were found not to engage patients in reimbursement decision-making typically have immature HTA processes (e.g. Vietnam). This correlation suggests that as countries implement and develop their HTA processes, they will increasingly include this important stakeholder group. However, though patients can provide important disease perspectives, this needs to be balanced against the fact that reasons for rejecting drugs often hinge on economic grounds rather than the clinical benefits of the technology and the need for fair, transparent and objective processes in payer decision-making.