Since 2007, 23 Núcleos de Avaliação de Tecnologias em Saúde or hospital-based health technology assessment (HB-HTA) units have been established in teaching hospitals across Brazil. These units aim to promote the development of health technology assessment in hospitals, assisting the decision-making process for implementing new technologies and evaluating and promoting the rational use of widespread technologies.

An online questionnaire was sent by e-mail to all HB-HTA units registered in the Brazilian Network for Evaluation of Health Technologies. Information was acquired to comprehensively assess the activity of the units.

All 23 HB-HTA units answered the questionnaire. Of these, 65 percent had a technology prioritization process. The technologies assessed included drug therapies (73%), equipment (64%), medical devices (64%), clinical protocols (46%), and emerging technologies (27%). The dimensions of health technology assessment (HTA) evaluated by these organizations were: efficacy (76%); effectiveness (67%); safety (67%); costs (52%); cost effectiveness or cost utility (52%); and budget impact (43%). The hospital departments that required more HTA studies were: cardiology (50%); infectious diseases (45%); hospital management (45%); oncology (40%); surgery (40%); and endocrinology (20%). HTA studies supported: incorporation of new technologies (81%); protocol or guideline development (57%); new indications for already approved technologies (38%); and withdrawal of obsolete technologies (29%). Half of the institutions also conducted educational or training activities. The main difficulties reported were a lack of trained professionals (78%), funding (70%), and material resources (48%).

For low- and middle-income countries, the process of implementing HB-HTA units remains a challenge. Even though human resources and funding are scarce, HB-HTA units continue to develop. Given their importance in the decision-making process, it is imperative that every effort is made to ensure their activities continue.

Innovative digital health technologies (DHTs) may present new aspects of value that are not appropriately accounted for in current health technology assessments. In discovering what value means in the context of DHTs, multi-stakeholder collaboration is essential.

A scoping literature review was conducted to identify current value assessment criteria and proposed methodologies across three health systems: United States of America, United Kingdom, and Germany. A Delphi exercise was conducted with stakeholders from the following groups: users, healthcare practitioners, decision-makers, supply-side actors, and influencers. Based on a review of assessment frameworks in the study countries and consultations with experts from each stakeholder group, researchers proposed value constructs in five domains: health inequalities, data rights and governance, technical and security, economic characteristics, clinical characteristics, and user preferences. In Delphi round one, participants commented on the proposed constructs and submitted their own. A thematic analysis identifying key concepts and themes of the participant proposed constructs and comments was used to incorporate this information for round two. Then, participants rated each value construct on an ‘importance’ Likert scale in two decision contexts: user-facing DHTs and system-facing DHTs. In round three, participants were presented with the consensus judgement for each construct, with the opportunity to change their answer. Value constructs with equal to or greater than 70 percent consensus were included in the final framework. Rounds four and five were, respectively, value judgements on a Likert scale and a presentation of consensus for a therapeutic area to test the final framework.

Initially 32 value constructs were proposed by researchers, 20 of which were changed or removed based on round one feedback. Additional constructs were added based on participant suggestions resulting in forty-five value constructs in round two. The final framework will be available after round three closes on 20 December 2022.

The multi-stakeholder Delphi approach ensures that all suggestions and value judgements are weighted equally across stakeholder groups. The resultant value framework can be used to inform policymaking around health technology assessment of DHTs.

The rising costs of drugs have necessitated the exploration of innovative payment methods in healthcare systems. Risk-sharing agreements (RSAs) have been implemented in many countries as a value-based payment mechanism to manage the uncertainty associated with expensive technologies. This study aimed to investigate stakeholder perspectives on value-based payment in the Singaporean context, providing insights for future directions in health technology assessment and financing.

This descriptive qualitative inquiry involved participant interviews conducted between October 2021 and April 2022. Thematic analysis was conducted in two phases to analyze the interview transcripts.

Seventeen respondents participated in the study, and five key themes emerged from the analysis. Stakeholders viewed RSAs as moderately positive, despite limited experience with them. They emphasized the importance of clearly defining objectives and establishing transparent criteria for implementing these schemes. The current data infrastructure was identified as both a barrier and facilitator, as RSAs impose administrative burdens. To successfully implement these payment mechanisms, capacity building, and effective stakeholder engagement that fosters mutual trust and cocreation are crucial.

This study confirms previously identified barriers and facilitators to successful RSA implementation while contextualizing them within the Singaporean setting. The findings suggest that value-based payment has the potential to address uncertainty and improve access to healthcare technologies, but these barriers must be addressed for the schemes to be effective.