Exploring the challenges of developing hospital-based health technology assessment in Iran: a qualitative study

BACKGROUND: Hospital-based Health Technology Assessment (HB-HTA) is increasingly recognized as a strategy to support evidence-informed decision-making at the hospital level, particularly in resource-constrained settings. This study explored the challenges of developing HB-HTA in Iran from the perspectives of health system experts. METHODS: This qualitative descriptive study was conducted from July 2023 to February 2024. Data were collected through in-depth, semi-structured interviews with 26 health system experts selected via purposive sampling and supplemented with snowball sampling. Data were analysed using thematic analysis following Braun and Clarke's six-phase framework, supported by MAXQDA version 10 software. Credibility was enhanced through member checking with five participants outside the research team, investigator triangulation involving four researchers with expertise in health policy and HTA and consensus-based resolution of coding disagreements. RESULTS: Analysis identified five main themes and 12 subthemes describing barriers to HB-HTA development in Iran. The themes included structural and organizational challenges, resource limitations, cultural and attitudinal barriers, knowledge and capacity gaps and external systemic constraints. Findings highlighted the lack of institutionalization of HB-HTA, inadequate policy support, limited trained personnel, resistance among clinicians, weak research culture, centralized governance and poor stakeholder collaboration. CONCLUSIONS: The study provides critical insights into the multifaceted challenges hindering HB-HTA in Iran. The findings are valuable for policymakers, hospital managers and healthcare professionals by offering practical guidance to strengthen institutional capacity, improve evidence-informed decision-making and advance HTA integration into hospital systems. Addressing these barriers through targeted reforms and inclusive strategies could enhance efficiency, equity and quality of care.