BACKGROUND: Equity in the provision of healthcare and access to health resources is vital, and payers/health technology assessment bodies (HTAs) are in a position to support equitable access to technology within their patient populations.

METHODS: We evaluated if and how major HTAs take health disparities into account in technology appraisals, by reviewing formal submission requirements and parameters for topic selection. We then reviewed publicly available appraisals made for products treating conditions in which there are well-known disparities: crizanlizumab (sickle cell anemia), alirocumab (hypercholesterolemia), and buprenorphine extended-release injections (opioid use disorder) to identify if disparity-specific information was included in the appraisals.

RESULTS: Of the 7 HTAs reviewed, 3 (CADTH, AMCP, AMNOG) did not request information related to disparities as part of the submission, while 4 (ICER, NICE, SMC, PBAC) did encourage manufacturers to discuss their technology in relation to existing disparities. None formally integrated inequity considerations in comparative effectiveness analyses. Six HTAs solicited patient input into the assessment, during which discussion of disparities often arose. In the appraisals of crizanlizumab, alirocumab, and buprenorphine, most HTAs recognized potentially disadvantaged populations, acknowledged equal access to care concerns, or identified gaps in representation in clinical studies. NICE and ICER most consistently addressed inequities. For crizanlizumab, both NICE and ICER discussed that higher cost-effectiveness ratios may be warranted if the product could reduce health inequalities.

CONCLUSION: The current status of HTAs falls short of incorporating health disparities into the value assessment of new technologies. With the recent legal framework for Joint Clinical Assessment, there is the opportunity to consistently request information from manufacturers and to establish a process of weighing the potential impact of a technology on health disparities across the EU and may eventually serve as a model for other HTAs.