Health Technology Assessment in High, Middle, and Low-income Countries: New Systematic and Interdisciplinary Approach For Sound Informed-policy Making: Research Protocole

Assessing the development of health technology assessment in Iran: a policy analysis using Kingdon's Multiple streams framework: a qualitative study

BACKGROUND

Health Technology Assessment (HTA) is crucial for optimizing healthcare investments and improving system efficiency. In Iran, the rising costs of healthcare technologies and systemic inefficiencies have highlighted the need for a structured HTA framework. However, despite academic discussions, HTA has not yet been fully integrated into formal health policy. This study explores the development of HTA in Iran using Kingdon's Multiple Streams Framework to identify challenges and opportunities for its advancement.

METHODS

The study employed qualitative methods, including 16 semi-structured interviews with key stakeholders in Iran's healthcare system. Participants, consisting of 12 males and 4 females with an average age of 41.56 years and an average work experience of 14.37 years, provided insights into the current state of HTA. The participants included individuals in key leadership roles within public and private institutions, such as the Ministry of Health and Medical Education, hospital managers, policymakers, and senior academics. Data were analyzed using Kingdon's framework to examine the problem, policy, and politics streams, as well as the role of policy entrepreneurs and potential policy windows.

RESULTS

Findings revealed that the rising costs of healthcare technologies, particularly imported ones, and inefficiencies in technology use were major concerns. Participants indicated that HTA could address these issues by ensuring cost-effectiveness and better health outcomes. Despite the technical feasibility of implementing HTA in Iran, there is a significant gap between theoretical discussions and policy action. Resistance from the private sector and the need for political backing were identified as major barriers. However, the political climate in Iran is becoming increasingly favorable, with growing interest in healthcare efficiency and transparency. The Covid-19 pandemic and healthcare shortages have exposed vulnerabilities, presenting potential opportunities for HTA's adoption. Leadership roles in key institutions, including the Ministry of Health and Medical Education, were identified as vital to advancing HTA initiatives. Policy entrepreneurs play a crucial role in advocating for HTA and capitalizing on these opportunities.

CONCLUSION

HTA is recognized as a valuable tool for improving healthcare efficiency and equity in Iran. However, significant challenges remain in transitioning from academic discussions to formal policy. The political environment and recent healthcare crises offer opportunities to advance HTA. To successfully integrate HTA into Iran's healthcare system, it is essential to address existing barriers, leverage political interest, and support policy entrepreneurs. The experiences of other countries, especially those with strong institutional leadership in HTA, provide useful models for Iran to follow in its HTA development journey.

The Lebanese health economic evaluation guideline

BACKGROUND

Economic evaluation guidelines (EEGs) serve as a valuable tool to assist appraisers in making consistent and transparent recommendations, standardize EE studies, enhance their quality, and minimize methodological uncertainties. As other LMICs, Lebanon aims for UHC where EEG is a necessity. This paper aims to report on the Lebanese health EEG (LEEG) and its reference case, including the intermediate results leading to the final decisions.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬.

RESEARCH DESIGN AND METHODS

The LEEG followed a structured, systematic, and transparent process: (1) identifying the rationale and the guideline scope; (2) establishing the Guideline Development Group; (3) searching the evidence; (4) planning the development process; (5) selecting the panel for the deliberative process; (6) surveying Lebanese stakeholders; (7) deliberating on the results; (8) drafting the guideline; and (9) consulting with international experts.

RESULTS

The LEEG includes three general characteristics, 19 key features, a reference case, and an action plan.

CONCLUSIONS

The LEEG is the first national EEG for health interventions. It will help decision-makers, researchers, and healthcare providers improve the quality and assessment of EE in Lebanon to identify the most cost-effective health interventions. Implementing LEEG is crucial to promoting an equitable, efficient, and high-quality health system with a more consistent decision-making process.

Unleashing the potential: the imperative of political support for health technology assessment in Iran

Health Technology Assessment (HTA) is essential for evidence-based healthcare decision-making, yet its integration into Iran's healthcare system faces political and logistical challenges. Despite HTA's potential to improve resource allocation, limited awareness, data gaps, and competing priorities hinder its implementation. This commentary emphasizes the need for political support, advocating capacity-building, collaboration, and alignment with long-term health policies. Leveraging international partnerships and monitoring outcomes can enhance HTA's role in improving healthcare in Iran and contributing to global health advancements.

Systematic Review of Tools and Approaches for Evaluating the Transferability of Health Technology Assessments Across Different Jurisdictions

BACKGROUND

This study aims to review tools that have been developed for the transferability of health technology assessment (HTA) information to different countries. HTA is increasingly being used as a tool in health policy decision-making, but its complexity and lack of local expertise have limited its usage in many countries. The World Health Organization (WHO) has taken measures to encourage countries to conduct and use HTA, including through resolutions from the Eastern Mediterranean (EM) Regional Committee in 2019. However, due to limitations in national technical capacities, there is a need to adapt HTA information from other settings to fit the specific context of each country. Therefore, this study aims to systematically review the tools that have been developed for HTA transferability and assess their strengths and limitations.

METHODS

The systematic review included studies that introduced tools, methods, and frameworks for transferability of HTA information across jurisdictions. Databases such as MEDLINE, EMBASE, Cochrane Library, Epistemonikos, Web of Science, health economic database, Scopus, and Google Scholar were searched, along with relevant bibliographies. The data was extracted and synthesized using both tabulation and narrative approaches. The evaluation of the tools involved assessing various criteria, such as user-friendliness, efficiency in screening, and considerations regarding transferability factors.

RESULTS

A total of 10 375 documents were evaluated, resulting in 17 studies that met the inclusion criteria. These 17 studies consisted of 13 newly developed tools/methods that were appraised. The majority of the models were checklists, with only a few deemed suitable for full HTA. Three models have been validated through published studies, but there is no evidence of utilization in the countries of the EM region.

CONCLUSION

While the existing tools provide valuable resources for evaluating transferability, there remains a need for a more comprehensive tool to support decision-makers in low-resource settings considering country context and capacity.

Developing the Lebanese health economic evaluation guideline

OBJECTIVE

To report on the process of developing the Lebanese Economic Evaluation Guideline (LEEG), and to provide relevant material that could assist guideline developers in the future.

METHODS

The development of the LEEG closely followed the process proposed by the World Health Organization, i.e. to set up a Guideline Development Group (composed of three Lebanese experts), to establish the rationale for developing the guideline in Lebanon, to identify its scope, to search and retrieve evidence through two systematic reviews, to assess and present the evidence, to translate the evidence into guidelines and recommendations through a deliberative process, and to consult international experts. The deliberative process included a survey, an in-person interview, and a consensus workshop with 16 Lebanese key stakeholders. Data was collected and quantitative analysis was conducted using SPSS software. International experts from Maastricht University - The Netherlands were consulted for issuing the LEEG. Supported by the Lebanese Ministry of Public Health (MoPH), the LEEG will be available for public consultation on the MoPH's webpage, and a final version will be made available thereafter.

CONCLUSION

Clear and transparent reporting of the guideline development process should support international organizations as well as other developers in establishing their guidelines within their national context.

The role of Iran's context for the development of health technology assessment: challenges and solutions

Health technology assessment (HTA) is a comprehensive and structured evaluation that aims to analyze the potential impacts of health technologies, including medical devices, diagnostic tools, pharmaceuticals, and public health interventions. Its purpose is to provide policymakers with evidence-based information to inform decisions related to the utilization and implementation of these technologies. HTA allows for the comparison of various scenarios related to a technology across a wide range of factors. This can aid in the creation of an essential drug list and health benefits package that is tailored to the actual needs of the community within a given healthcare system. In the present paper, we review the role of Iran's context for the development of HTA, in terms of challenges and solutions.

SPINE20 recommendations 2022: spine care-working together to recover stronger

PURPOSE

Globally, spine disorders are the leading cause of disability, affecting more than half a billion individuals. However, less than 50% of G20 countries specifically identify spine health within their public policy priorities. Therefore, it is crucial to raise awareness among policy makers of the disabling effect of spine disorders and their impact on the economic welfare of G20 nations. In 2019, SPINE20 was established as the leading advocacy group to bring global attention to spine disorders.

METHODS

Recommendations were developed through two Delphi methods with international and multi-professional panels.

RESULTS

In 2022, seven recommendations were delivered to the leaders of G20 countries, urging them to: Develop action plans to provide universal access to evidence-based spine care that incorporates the needs of minorities and vulnerable populations. Invest in the development of sustainable human resource capacity, through multisectoral and inter-professional competency-based education and training to promote evidence-based approaches to spine care, and to build an appropriate healthcare working environment that optimizes the delivery of safe health services. Develop policies using the best available evidence to properly manage spine disorders and to prolong functional healthy life expectancy in the era of an aging population. Create a competent workforce and improve the healthcare infrastructure/facilities including equipment to provide evidence-based inter-professional rehabilitation services to patients with spinal cord injury throughout their continuum of care. Build collaborative and innovative translational research capacity within national, regional, and global healthcare systems for state-of-the-art and cost-effective spine care across the healthcare continuum ensuring equality, diversity, and inclusion of all stakeholders. Develop international consensus statements on patient outcomes and how they can be used to define and develop pathways for value-based care. Recognize that intervening on determinants of health including physical activity, nutrition, physical and psychosocial workplace environment, and smoking-free lifestyle can reduce the burden of spine disabilities and improve the health status and wellness of the population. At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations.

CONCLUSION

SPINE20 advocacy efforts focus on developing public policy recommendations to improve the health, welfare, and wellness of all who suffer from spinal pain and disability. We propose that focusing on facilitating access to systems that prioritize value-based care delivered by a competent healthcare workforce will reduce disability and improve the productivity of the G20 nations.