Session (CTI)

Issue Many smaller European countries, especially but not exclusively in Central Europe, have adopted HTA frameworks modelled on the UK cost-effectiveness paradigm, yet they operate in fundamentally different institutional contexts, with resource constraints, limited data availability, greater sensitivity to short-term budget impact than to cost-effectiveness and institutional traditions where negotiation is the primary mechanism to decide about access. The result is a mismatch: heavy cost-per-QALY assessments consume significant resources and delay access while not necessarily providing payers with the information they actually need to negotiate procurement deals across price, volume, indication, and lifecycle dynamics. Although this problem statement is widely shared, reform proposals considerably differ in which redesign should come first. Overview This panel debates competing variations for procurement-focused HTA. The four participants agree that HTA must move from blocker to enabler of procurement, but they prioritize the first step differently. The moderator, Lou Garrison frames procurement-focused HTA and the three competing proposals for redesign (5 min). Each panellist (10 min) advocates for a different first move: proportionate review leveraging evidence generated elsewhere, with governance to adapt it locally (Jorge Mestre-Ferrandiz); rapid prioritization by health gain and disease burden (Dávid Dankó); and integrated added-benefit assessment driving price-volume agreements as system-level contracts, drawing on French and Italian practice (Olivier Wong). The moderator then opens the debate, pressing each panellist on the role of formal cost-effectiveness analysis, the transferability of foreign assessments, and whether the cost-effectiveness threshold should serve as a negotiation anchor. Audience polling will identify which redesign carries most potential for smaller European markets. The session is aimed at HTA agency leaders, payers, manufacturers, and policy researchers working with smaller or transitioning European health systems.