Scoping review

In our scoping review, we identified scientific and gray literature describing competencies for HTA expertise. Figure 1 presents the PRISMA flowchart of the search. The systematic literature search resulted in 1296 articles after removing duplicates, of which 69 articles were initially selected based on title and abstract screening. After reading the full text, thirteen articles were included and fifty-six articles were excluded; see Supplementary Table S3 for exclusion reasons. One author was contacted to retrieve the full text of an article, but no response was received, which resulted in exclusion of the article. Another author was contacted to retrieve the methods used for the competency framework development, which were sent by email. The gray literature search resulted in the initial identification of eleven documents, of which nine were identified using the search and two were identified via snowballing. After reading the full documents, six documents were included and five were excluded; see Supplementary Table S3 for exclusion reasons. Reference and citation checking of Mueller et al. (Reference Mueller, Gutierrez-Ibarluzea, Chiumente and Oortwijn8) resulted in no additional articles. A total of nineteen documents (Reference Dixon, Tyagi and Singh10;Reference Refolo, Bond and Bloemen11;Reference Pizzi, Onukwugha, Corey, Albarmawi and Murray16;Reference Bidonde, Meneses-Echavez and Asare17;Reference Low, André-Vert, Fanelli and Galbraith21–Reference Wu, Chen, Wang, Jian and Ko23;Reference Abraham, Kvamme and Magrin Sammut26–Reference Zemplényi, Tachkov and Balkanyi37) describing competencies for HTA expertise were included.

Figure 1.

PRISMA flowchart of the scoping review. ISPOR: International Society for Pharmacoeconomics and Outcomes Research, IHEA: International Health Economics Association, SMDM: Society for Medical Decision Making, EUPHA: European Public Health Association, ISOQoL: International Society for Quality of Life Research, HTAi: Health Technology Assessment International, DIA: Drug Information Association, ISPH: International Society for Priority Setting in Health, ISPE: International Society for Pharmaceutical Engineering, ISPE*: International Society of Pharmacoepidemiology.

Figure 1. Long description

At the top, two main branches represent scientific literature search and graey literature search. The scientific literature search starts with records identified from six sources: PubMed 538, Embase 1065, PsycInfo 66, Web of Science 573, E R I C 7, and C I N A H L 123, totaling 2372. After removing duplicates, 1296 records remain. These are screened, with 69 full text records assessed for eligibility. Of these, 56 are excluded for reasons: conference abstract 34, no competencies described 16, no method described 2, full text not available 2, capacity on group level 1, best practices not on specific domain 1. Thirteen records are included in synthesis. The gray literature search includes records identified via snowballing 2, from websites 9 (I S P O R 3, I H E A 1, S M D M 1, E U P H A 1, I S O Q O L 1, H T A I 1, D I A 1, I S P H 0, I S P E 0, I S P E star 0), and via reference and citation checking 0. Eleven full records are assessed for eligibility, with five excluded for no framework. Six records are included in synthesis. Both branches converge at the bottom, showing a total of 19 records included.

Six competency frameworks, one handbook, and twelve scientific articles describing knowledge, skills, and attitudes for HTA expertise were identified. Table 2 presents the main characteristics of the documents and a detailed overview is provided in Supplementary Table S4. Most documents were developed with representatives from countries across several continents (n = 6) or from Europe (n = 4). Academia (n = 10) and national government organizations (n = 8) were the most frequently involved organizations, and target populations mostly included HTA professionals (n = 5) or decision makers (n = 5).

Table 2.

Main characteristics of the identified documents describing competencies for HTA expertise

Table 2. Long description

The table contains 18 rows, each representing a document on HTA competencies. Columns are References, Country, Aim, Organizations involved, and Target population. From the top row: Abraham et al. 26, Malta, capacity building process in countries beginning to implement HTA, National Health Care Institute, i M T A, and Ministry of Health of Malta, HTA assessors in Malta. Al Rabayah et al. 27, Jordan, capacity building process in countries beginning to implement HTA, Centre for Drug Policy and Technology Assessment at the pharmacy department of King Hussein Cancer Center, hospital pharmacists in Jordan. Bidonde et al. 17, Ghana, questionnaire about HTA expertise, Ghana's Ministry of Health and the Norwegian Institute of Public Health, individuals who would potentially contribute to any activity in HTA in Ghana. Czabanowska et al. 28, Europe, competency framework, W H O and A S P H E R, public health professionals. Dixon et al. 10, India, competency framework, Government of India and University of Sheffield, technical staff within Regional Resource Centers and the secretariat in India. Goodman et al. 29, International, handbook, HTAi Early Career Network and Interest Group Scientific Development and Capacity Building, basic users of HTA. Low et al. 21, France, overview of training tools, French National Authority for Health, patient and consumer groups internationally. Mohamad et al. 30, Malaysia, questionnaire about HTA expertise, four public universities in Klang Valley, Malaysia, medical students in Malaysia. Norris et al. 31, Australia, competency framework, University of Sydney and Australian government, Australian government staff. Oortwijn et al. 32, International including H I C and L M I C, recommendations or best practices, Joint HTAi forward slash I S P O R task force, executive and legislative actors responsible for establishing and managing HTA processes, particularly HTA bodies. Pizzi et al. 16, International, competency framework, I S P O R Institutional Council, H E O R researchers. Refolo et al. 11, International H I C and L M I C, competency framework, HTAi Interest Group on Ethical Issues in HTA, ethical experts in HTA. Riera et al. 22, Brazil, capacity building process in countries beginning to implement HTA, Health Technology Center from Hospital Sirio-Libanes, A N S the National Supplementary Health Agency and the Brazilian Ministry of Health, advanced doers in Brazil. Sonstein et al. 33, International all H I C, competency framework, Joint Task Force for Clinical Trial Competency, clinical research professionals. Soril et al. 34, Canada, Australia, and the United Kingdom, recommendations or best practices, University of Calgary in Canada, the University of Melbourne in Australia, and Imperial College London in the United Kingdom, health technology reassessment experts. Surgey et al. 35, Tanzania, capacity building process in countries beginning to implement HTA, Ministry of Health and Programs for Assessment of Technology in Health, representatives from the Ministry of Health of Tanzania. Uzochukwu et al. 36, Nigeria, capacity building process in countries beginning to implement HTA, University of Nigeria, International Decision Support Initiative, West Africa Health Organization, University of Queensland, decision makers in Nigeria. Wu et al. 23, Taiwan and other countries not specified in the article, questionnaire about HTA expertise, academia, industrial sector, and government, HTA professionals international. Zemplenyi et al. 37, European Union with emphasis on Central Eastern European countries, recommendations or best practices, HTx consortium members Horizon 2020 project, healthcare decision makers. Table footnotes define abbreviations: A N S, Ag ê ncia Nacional de Sa ú de Suplementar the National Supplementary Health Agency; A S P H E R, Association of Schools of Public Health in the European Region; H E O R, Health Economics and Outcomes Research; H I C, high-income country; HTA, health technology assessment; HTAi, health technology assessment international; i M T A, Institute for Medical Technology Assessment; I S P O R, Professional Society for Health Economics and Outcomes Research; L M I C, low-and middle-income country; W H O, World Health Organization.

ANS, Agência Nacional de Saúde Suplementar (the National Supplementary Health Agency); ASPHER, Association of Schools of Public Health in the European Region; HEOR, Health Economics and Outcomes Research; HIC, high-income country; HTA, health technology assessment; HTAi, health technology assessment international; iMTA, Institute for Medical Technology Assessment; ISPOR, Professional Society for Health Economics and Outcomes Research; LMIC, low-and middle-income country; WHO, World Health Organization.

Content analysis

Using deductive content analysis, we compared the competencies for HTA expertise identified in the literature to those listed in the original competency framework of Mueller et al. (Reference Mueller, Gutierrez-Ibarluzea, Chiumente and Oortwijn8). Figure 2 shows the results of the content analysis. The process domain Scoping was represented in all the documents and the domains Synthesis of evidence and Introduction into HTA were also represented in most documents. The domains Safety and Patient and Social aspects were mentioned in the least number of documents. Overall, we found that all original competencies described in the framework by Mueller et al. (Reference Mueller, Gutierrez-Ibarluzea, Chiumente and Oortwijn8) were represented in at least five of the included documents, suggesting a verification that the existing HTA competencies are supported by the current literature.

Figure 2.

Mapping results of the competencies described in the identified literature with the domains of the original competency framework. Green sections represent that competencies within this domain are represented in the document. Blue sections indicate the new competencies in the existing domains and orange the new competency domains. HTA: Health Technology Assessment.

Figure 2. Long description

Starting from the top-left, the table lists competency domains vertically and documents horizontally. Each row represents a domain such as Health problem and current use of the technology, Description and technical characteristics, Safety, Clinical effectiveness, Costs and economic evaluation, Ethical analysis, Organisational aspects, Patient and social aspects, Legal aspects, Introduction to H T A, Prioritization, Scoping, Real world data, Synthesis of evidence, Dissemination, H T A report, Stakeholder engagement in H T A, Stakeholder identification, Communication and others, Artificial Intelligence in H T A, Environmental aspects, and Performance and achievements. Each column from left to right is labeled with a document name and year, including Abraham 2024, Al Ibrah 2018, Bidonde 2020, Dabrowska 2020, Dioxon 2024, Goodman 2023, Low 2023, Mohamad 2024, Norris 2024, Oortwijn 2022, Pizzi 2020, Rehbo 2020, Riee 2023, Soinne 2023, Sun 2021, Uzochukwu 2020, Iwu 2022, and Zemplenyi 2023. Green cells indicate a domain is covered in a document, blue cells indicate subdomains or specific aspects, and orange cells at the bottom highlight unique or less common competencies. The rightmost column totals the number of documents covering each domain, with Synthesis of evidence and Scoping being the most frequently mapped. The table visually demonstrates the distribution and overlap of competencies across the literature.

We identified new competencies that can be included in an existing domain in the original framework. First, we identified the competencies required for interpreting and developing HTA reports, such as full, rapid, and mini HTA reports (Reference Merlin, Tamblyn and Ellery38). It is important that HTA professionals have expertise in this competency because they need to be able to interpret and communicate the results of HTA effectively to different stakeholders. This facilitates the appropriate use of HTA results and effective translation into policy (Reference Dixon, Tyagi and Singh10;Reference Refolo, Bond and Bloemen11;Reference Czabanowska, Shickle and Burazeri28;Reference Oortwijn, Husereau and Abelson32;Reference Sonstein, Namenek Brouwer and Gluck33;Reference Uzochukwu, Okeke and O’Brien36). Second, the competency patient and public involvement were identified, which include considering patient and public views in HTA as well as assessing patient-reported outcomes. This competency is important for HTA professionals as these aspects are increasingly integrated into HTA processes to support decision making (Reference Pizzi, Onukwugha, Corey, Albarmawi and Murray16;Reference Low, André-Vert, Fanelli and Galbraith21;Reference Goodman29;Reference Norris, Huckel Schneider, Howard, Merlin and Elshaug31;Reference Uzochukwu, Okeke and O’Brien36). Furthermore, we identified real-world data as a source of evidence for HTA (Reference Pizzi, Onukwugha, Corey, Albarmawi and Murray16;Reference Czabanowska, Shickle and Burazeri28;Reference Goodman29;Reference Sonstein, Namenek Brouwer and Gluck33) and identification of relevant stakeholders in HTA (Reference Refolo, Bond and Bloemen11;Reference Bidonde, Meneses-Echavez and Asare17;Reference Czabanowska, Shickle and Burazeri28;Reference Norris, Huckel Schneider, Howard, Merlin and Elshaug31) as new competencies. Real-world data (RWD) as a source of evidence for HTA is emerging globally, because an increasing number of health technologies enter the market via pathways with limited or no evidence from randomized clinical trials (RCTs). This requires additional evidence collected, for example, via postmarketing surveillance or RWD sources, to determine its value. There is also an increased interest from HTA organizations in complementing RCTs with RWD, for example, to better understand patient outcomes in practice and how it can inform outcome-based managed entry agreements (Reference Oortwijn, Sampietro-Colom and Trowman39). As the use of RWD comes with its own methodological challenges, such as confounding and missing data, expertise on whether and how this evidence should be considered in HTA is essential. Lastly, the competency of organizational sustainability was identified, which includes affordability, effective use of resources, and especially workforce management. It is important for HTA professionals to interpret and analyze organizational sustainability, as scarcity of resources is increasingly used to guide decisions. For example, policy makers as well as healthcare managers worldwide are requesting evidence on the impact of health technologies on the scarce healthcare workforce performance and workload (Reference Czabanowska, Shickle and Burazeri28;Reference Sonstein, Namenek Brouwer and Gluck33;Reference Soril, Elshaug and Esmail34).

In addition, we identified three new competency domains that are not yet part of the original competency framework. These were artificial intelligence (AI) use in HTA, environmental aspects of health technologies, and performance and achievements of HTA professionals. Competencies related to AI use in HTA involve how to use AI in different parts of the assessment, such as assisting in literature reviews or analyzing data (Reference Zemplényi, Tachkov and Balkanyi37). Competencies on environmental aspects include, for example, describing the importance of identifying environmental determinants in health and the main features of the climate change process (Reference Czabanowska, Shickle and Burazeri28). Lastly, competencies related to performance and achievements enable HTA professionals to successfully perform their jobs and achieve desired results. These include business management, career and personal development, networking, mentoring and teaching, dealing with stress and uncertainty, as well as adhering to scientific principles (Reference Refolo, Bond and Bloemen11;Reference Pizzi, Onukwugha, Corey, Albarmawi and Murray16;Reference Bidonde, Meneses-Echavez and Asare17;Reference Wu, Chen, Wang, Jian and Ko23;Reference Czabanowska, Shickle and Burazeri28;Reference Goodman29;Reference Sonstein, Namenek Brouwer and Gluck33).