The global landscape of country-level health technology assessment processes: A survey among 104 countries

To make progress towards universal health coverage (UHC), countries need to be able to develop and implement evidence-informed and inclusive processes for decision-making to inform what services are provided and purchased. Health Technology Assessment (HTA) processes are an established mechanism to support evidence-informed decision-making in the health sector. To assess the practice of HTA in countries, WHO conducted a global survey that explores the status of HTA. The survey is the largest source of information in terms of number of countries for describing global HTA status. The final sample analysed in this paper is the 104 countries (82% or 104/127) that responded "yes" to the question of having a systematic, formal health decision-making process at the national level. The results show that while many countries have HTA bodies in place, these serve different functions. While there are more established processes in higher income country groups, even those show room for improvement in areas such as social participation and appeals. Lack of awareness of the importance of HTA and institutionalization were the top two barriers to HTA utilization. There is further progress that needs to be made in HTA globally. Countries need to build on available guidance to ensure the appropriate elements are in place for sustainable country decision-making processes and develop more understanding of how they vary across settings.