Why do health technology assessment drug reimbursement recommendations differ between countries? A parallel...

Area of Science:

• Health Economics
• Health Policy Analysis
• Decision Science

Background:

• Health Technology Assessment (HTA) plays a crucial role in drug reimbursement decisions globally.
• Existing research highlights various factors influencing HTA recommendations but lacks an integrated framework.
• Understanding cross-country variations in HTA drug reimbursement is vital for policy and access.

Purpose of the Study:

• To develop a comprehensive conceptual framework integrating factors influencing HTA drug reimbursement decisions.
• To explore the relationships between identified factors.
• To assess the congruence, complementarity, or discrepancy of these factors across different countries.

Main Methods:

• A parallel convergent mixed methods design was employed.
• Case studies of four countries (England, Sweden, Scotland, France) with prior HTA research were utilized.
• A conceptual framework was developed by integrating findings from previous quantitative and qualitative studies.

Main Results:

• A framework distinguishing between macro-level and micro-level factors was established.
• Congruence was observed in two common factors, while stakeholder input and external evidence review yielded discrepant conclusions.
• Most identified factors were complementary, collectively enhancing the understanding of HTA decision-making.

Conclusions:

• Differences in HTA drug reimbursement recommendations stem from a complex interplay of factors.
• The deliberative process within HTA is a critical component influencing final recommendations.
• An integrated approach provides a more complete picture of the drivers behind varied HTA outcomes.