The rapid evolution of digital health technologies (DHTs) presents distinct challenges for health technology assessment (HTA). Existing HTA frameworks, largely designed for conventional health interventions, may not sufficiently address these unique complexities. This scoping review provides an overview of existing assessment frameworks for DHTs, analyzing their purpose and the guidance they offer within the domains of the EUnetHTA Core Model.

The review followed the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. The literature was identified through searches in PubMed and Embase, covering publications from 2015 to 2024 in English or German, and was complemented by a manual hand search. The studies were screened and analyzed using Covidence, with data categorized inductively based on the EUnetHTA Core Model domains.

Of 3,576 screened records, 15 met inclusion criteria; an additional 45 frameworks were identified through hand searching, resulting in a total of 60 frameworks. Most frameworks focused on digital health applications (68 percent), while only a few addressed technologies such as artificial intelligence (2 percent). The frameworks primarily provide guidance on assessment, with varying focus on evidence requirements. The domains of the EUnetHTA Core Model were variably represented across the frameworks. Technical characteristics were most frequently addressed, while ethical, legal, and organizational domains received limited attention.

This review highlights the diversity of existing frameworks for DHT assessment. This emphasizes the potential relevance of a future standardized framework that contains explanations of the methodological approach to the assessment of DHTs and is modularly customizable depending on the type of technology.

Patient involvement is recognized as an integral component of health technology assessment (HTA), with patients’ lived experiences offering valuable insights that enhance the relevance, transparency, and quality of healthcare decision-making. In line with a national shift toward patient-centered care, Singapore’s Agency for Care Effectiveness (ACE) established formal processes for patient involvement in HTA in 2021. This paper describes ACE’s structured approach to identifying relevant patient organizations, co-developing processes, and building capacity to support meaningful patient input.

A stakeholder mapping exercise was undertaken to identify relevant local patient and volunteer organizations by searching the Singapore Charity Portal, hospital websites, search engines, and social media platforms. Identified organizations were screened against predefined criteria and contacted to determine their interest in ACE’s work. A process and methods guide, including survey templates, plain language materials, and training resources were co-developed with local patient organizations, drawing on international best practices, contextualized to local patients’ needs.

ACE identified 106 patient organizations across 20 health conditions. During a pilot initiative between August and December 2022, 82 patients from 10 organizations provided input into 7 HTAs. Sustained participation continued afterwards, with patient testimonials submitted for 85 percent of HTAs in the first year, increasing to 89 percent in the second year.

ACE’s patient involvement processes have improved the relevance and acceptance of HTA recommendations. Ongoing engagement with patient organizations, systematic evaluation of impact, and refinement of processes will be crucial to ensure that patient input continues to inform and advance healthcare decision-making in Singapore.

The overall aim is to understand the practices, views, and needs of health technology assessment (HTA) practitioners worldwide regarding the use of health-related quality of life (HRQoL) data for generating cost-effectiveness evidence.

We invited HTA practitioners in sixty countries to complete an online survey on their perspectives on the measurement and valuation of health. We performed descriptive analyses of the overall sample, examined response differences across six regions, and pooled responses to open-ended questions for content analysis.

A total of 238 individuals from 45 countries completed the survey, with a mean response number per country of 5.28 (SD: 4.45). Most responses came from public sector employees (seventy-two percent), and ninety percent were involved in cost-effectiveness-related work. The top three most frequently used utility instruments were EQ-5D, SF-6D, and EQ-5D-Y, and the elicitation methods were time trade-off, visual analogue scale, and standard gamble. Health-state preferences of the general public from another country were more frequently used than the preferences of the local public. Common data quality issues were poor sample representativeness and a small sample size of utility data. In Asia and Western Europe, the top-voted research priority was developing utility instruments that capture both healthcare and social care impact. In four regions, developing utility instruments for children was the second-highest research priority.

The survey addressed important knowledge gaps regarding current practices in measuring and valuing HRQoL in HTA and provided insights into HTA practitioners’ views on instruments, methods, and data-related challenges and needs for generating HRQoL evidence.

Guideline development handbooks outline the methodology that authoring organizations use to create public health and clinical practice guidelines (CPGs). We created an Equity Assessment Tool (EquAT) for guideline development handbooks to identify areas of improvement and foster conversations.

Sequential phases lead to tool development and face/content validation in this mixed-methods study. In phase 1, we reviewed the literature to generate a list of “essential elements” or tasks that are part of guideline development methodology, mapped “essential elements” with relevant equity concepts, and drafted our tool for use in reviewing guideline development handbooks. In phase 2, we surveyed experts for feedback on “essential elements” and explicit language for assessing equity within the tool and refined items. We piloted and finalized the tool based on feedback.

We identified 18 essential elements within five domains of guideline development and created a draft EquAT. Twenty of 25 invited experts responded to the online survey for feedback on the tool. Most experts provided limited feedback, and the most common suggestion was adding clarifying language to the existing tool criteria for assessing equity. Ten experts participated in pilot testing the revised tool. We found a diversity of scores, and potential reasons might be due to the complexity of the tool, differences in equity frameworks, and a variety of expertise. We incorporated their feedback and finalized the tool.

We developed and validated the EquAT, a tool to foster discussion among assessors about the extent of health equity considerations in guideline development handbooks.

While rapid health technology assessments (HTA) are important for decision makers, there is no universally accepted definition or standardized methods. The objective of this study was to analyze the content and conduct of published rapid and mini-HTA reports.

We conducted a cross-sectional analysis of rapid and mini-HTA reports identified from the International HTA Database (2014–April 2024) and supplementary searches of HTA agency websites. We extracted descriptive data on rapid HTA products; specifically, which traditional HTA domains were included or omitted, evidence synthesis methods, and approaches to interest-holder (formerly known as stakeholder) engagement. Data analysis was conducted in Stata.

We included 203 rapid HTA reports. Most frequently included HTA domains were clinical effectiveness (99 percent) and safety (82.3 percent). Legal aspects (12.3 percent) and budget impact analyses (10.8 percent) were less frequently reported. Across reports reviewing clinical effectiveness (n = 201), generic literature searches were the most predominantly self-reported evidence synthesis method (37.8 percent), with updates (1.5 percent) and overviews (2 percent) of systematic reviews less common. Cost-utility analyses were the most commonly self-reported form of economic evaluation (36.2 percent). Additionally, public consultations (68 percent) were the most commonly reported ways to engage with interest holders.

Our analysis highlights variations across rapid HTA reports and will contribute to wider research aiming to establish a clearer definition and framework of rapid HTAs and inform when and how rapid HTAs are performed. Clearer reporting and justification of simplifications in rapid HTA reports are needed.

Biosimilars are biological medicines highly similar to an authorized reference medicine, offering substantial cost savings and increased treatment access. Despite the regulatory framework in the UK and EU facilitating their approval, the biosimilar landscape remains small compared to small-molecule drugs. This study provides a horizon scanning overview of the current biosimilar landscape, procured through horizon scanning activities.

Data were sourced from ClinicalTrials.gov and the EU Clinical Trials Register, scanned monthly to identify innovative medicines in clinical development. We included biosimilars identified through horizon scanning from April 2017 to February 2025. Supplementary data were collected from the European Medicines Agency to ascertain approval status, and additional clinical trial information was manually extracted from relevant registries.

We identified 156 unique biosimilars developed across 174 clinical trials, with sixty-four approved by the MHRA and seventy-eight by the European Medicines Agency. Adalimumab, bevacizumab, and denosumab were the reference products with the most biosimilars in development. Most biosimilar trials were at phase III. There are seventy-one biosimilars in active development.

The development landscape of biosimilars in the UK and EU show high activity levels. Continuous improvements in horizon scanning methods and regulatory frameworks are essential to support the timely adoption of biosimilars, maximizing their benefits for healthcare systems.

Hospitals are at the front line of adopting new health technologies, yet decision-making is often hampered by insufficient evidence, limited context, and misaligned priorities. Hospital-based health technology assessment (HB-HTA) provides a structured mechanism to evaluate innovations at the institutional level. However, published accounts of HB-HTA implementation remain scarce, particularly in Asian contexts.

We describe Singapore General Hospital’s (SGH) approach to institutionalizing HB-HTA through a three-pronged strategy: (1) structured two-page narrative proposals to ensure clarity, rigor, and alignment with organizational priorities; (2) establishment of a dedicated HB-HTA team – the Impact Assessment, Program Evaluation, and Implementation Research team; and (3) targeted training programs to build capacity among clinical and managerial staff. Evaluation of the framework included formative feedback from proposers and senior leaders, surveys of participant satisfaction, and qualitative interviews.

Between 2023 and 2024, SGH piloted and scaled the HB-HTA framework, reviewing 15 proposals exceeding USD $40 million across domains, including artificial intelligence, robotics, diagnostics, and therapeutic devices. Training workshops engaged 55 participants with high Net Promoter Scores (≥50 percent), while surveys of senior leadership showed that 91 percent were satisfied or very satisfied with the process. Qualitative feedback highlighted improved strategic alignment, transparency, and confidence in decision-making.

SGH’s experience demonstrates that embedding HB-HTA requires deliberate organizational design, leadership commitment, and stakeholder engagement. By combining concise narrative proposals with independent in-house assessments, hospitals can strengthen governance, foster accountability, and support value-driven innovation. This model offers a practical roadmap for institutions seeking to formalize HB-HTA within their decision-making processes.

Many European countries independently conduct horizon scanning activities. However, the costs, time, and resources required can be prohibitive. To address this, the International Horizon Scanning Initiative (IHSI) was launched in 2019. IHSI aims to facilitate decision-makers and payers in negotiating fair prices and preparing for potentially disruptive pharmaceuticals. IHSI developed the Joint Horizon Scanning Database, a repository of pharmaceuticals expected to enter the European market, and initiated a series of High Impact Reports (HIRs) to highlight pharmaceuticals that have the potential to significantly impact healthcare systems. This paper outlines the development of key performance indicators (KPIs) that can be used to evaluate IHSI’s work.

In close collaboration with representatives from IHSI member countries and its Executive Committee, the following KPIs were developed: “Number of IHSI member countries”, “Embedding of IHSI in national health technology assessment procedures”, “Database coverage”, “Data completeness”, “Data timeliness”, “Accuracy of identifying disruptive pharmaceuticals”, “Accuracy of identifying non-disruptive pharmaceuticals”, “Use of HIRs in preparing for disruption to the healthcare system”, and “Use of HIRs in price negotiations and financial arrangements”. Among these, “Accuracy of identifying disruptive pharmaceuticals” was considered most important, followed by “Data timeliness” and “Data completeness”. Additionally, based on consultations with nonmember countries, strategies for improvement were identified should the KPIs reveal areas for improvement. These include involving patients in the selection of pharmaceuticals and conducting reputation surveys alongside measuring KPIs. While the KPIs and strategies for improvement are specific to IHSI, they can be tailored to support other (international) horizon scanning initiatives.

Economic evaluation supports public funding decisions about the use of health technologies within the Portuguese National Health System (NHS). The methods guide for economic evaluation in Portugal serves both companies preparing economic evaluation submissions and the independent commission appraising the evidence submitted.

This article presents the revised methods guide for economic evaluation in Portugal. The revisions reflect advances in economic evaluation, updates to regulatory policies, and responses to the evolving economic context. The paper highlights the most significant changes to the guidance, comparing the new Portuguese guidelines to those from the United Kingdom and Canada. The discussion is framed around key comments received during public consultation.

The updated guidelines recommend cost-effectiveness analyses based on quality-adjusted life years and advocate for long-term modelling, a 4 percent discount rate, and a focus on NHS costs. New features include guidance on the identification and management of uncertainty within a dynamic appraisal process with regular contract negotiations (which can trigger reappraisals). The guide also covers how cost-effectiveness models, typically centrally developed, should be adapted to the Portuguese context. It highlights the key role of structured expert elicitation to address uncertainties in evidence, including those related to model adaptation.

The revision was developed through stakeholder consultations and aligns with international best practices, offering more explicit and transparent methods to support health resource allocation decisions.

Cost-effectiveness analyses are used to help to inform resource-allocation decision-making in healthcare systems. The manufacturers of new health technologies may choose to employ “early cost-effectiveness analysis” (eCEA) to inform the technology development process in anticipation of a value-based assessment if and when the technology is launched. We aim to provide guidance on how eCEA can effectively inform health technology development processes, presenting novel methodological approaches to address key decision-making questions.

We present three core health technology development questions that eCEAs can address, as well as recommendations for deriving and presenting insights from eCEA models. A hypothetical treatment for cutaneous squamous cell carcinoma (CSCC) called “dummymab” demonstrates the analytic techniques and presentation formats.

We provide guidance for addressing: 1. What is a health technology’s value-based price (VBP) under a range of scenarios? 2. To what extent do different attributes of the technology contribute to its value? 3. Regarding what model parameters is further evidence most valuable? A novel net benefit approach for value driver analysis provides more reliable estimates than traditional ‘switch-on’ methods by avoiding parameter interaction effects. The manufacturer-perspective value-of-information framework enables evidence prioritization aligned with commercial decision-making while maintaining cost-effectiveness principles.

eCEA can systematically inform technology development through value-based price estimation, value driver identification, and evidence prioritization. Implementing development decision-making based on eCEA insights can foster alignment with value-based principles of HTA-orientated decision-making systems while supporting more efficient resource allocation in technology development.

This study aims to systematically identify and summarize the key characteristics of Mini-Health Technology Assessment (Mini-HTA) and assess the completeness of its basic reporting information, providing a theoretical foundation for developing future reporting guidelines..

A comprehensive search for Mini-HTAs was performed using CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, Web of Science, HTA database, and major HTA-related websites from inception until February 2024. The completeness of basic information reporting in Mini-HTAs was assessed using the INAHTA checklist. The key characteristics of the included Mini-HTAs were summarized descriptively. Microsoft Excel 2019 was used to analyze and visually present the data.

A total of 21 Mini-HTA reports were included, with the highest number published in 2021 (5 reports, 23.8 percent). China contributed the most reports (18 reports, 85.7 percent). The most common assessment purpose was technology comparison (15 reports, 71.4 percent), with general hospitals being the predominant assessment setting (17 reports, 80.9 percent), and drugs being the most frequently assessed technology type (14 reports, 66.7 percent). The INAHTA checklist evaluation identified notable deficiencies in reporting key methodological aspects, including participant roles, conflict of interest statements, data sources, literature search strategies, and methods for data assessment and analysis.

Mini-HTAs have significantly increased in China since 2020, mainly in technology comparison, drug evaluation, and general hospitals. However, gaps remain in reporting key aspects, such as participant roles, conflict of interest, and data sources. Future efforts should focus on refining reporting guidelines to improve consistency and address these reporting deficiencies in Mini-HTA.

The simultaneous existence of low-value health care and underutilization of high-value care are global problems. Health technology reassessment (HTR) aims to optimize the value for money of technologies already in use within health care. Identifying candidate interventions for HTR remains challenging. Therefore, we tested a novel method to identify candidate outpatient prescription drugs for HTR through practice variation.

We used administrative data for all publicly funded outpatient prescriptions dispensed to persons aged 65 or older in Alberta in 2023. Through quantitative comparison of funnel plots for Anatomic Therapeutic Chemical (ATC) classes at the fourth level stratified by prescriber specialty, variation in prescription dispensation rates between prescribers was used to estimate three outcomes: the number of prescribers affected, the number of patients affected, and the potential budgetary impact. We ranked combinations of ATC class and prescriber specialty in descending order for each outcome, with use above and below the mean considered separately.

We analyzed data on 17.5 million dispensations, encompassing more than 8,000 prescribers and approximately 600,000 patients. The top ATC class–prescriber specialty combinations for each outcome showed high similarity above and below control limits while exhibiting minimal overlap between outcomes.

Our method successfully identified ATC class–prescriber specialty combinations with marked variation in use, for potential advancement through the HTR process. Depending on the perspective of those undertaking HTR of prescription drugs, different outcomes may be useful in technology prioritization. To make the ATC class–prescriber specialty combinations actionable, future efforts should focus on exploring the patients affected.

Despite omics technologies gaining traction in clinical settings, particularly in oncology, challenges persist in their widespread adoption due to the pre-requisite robust evidence supporting efficacy and cost-effectiveness. This study aims to explore the experiences of organizations working in the health technology assessment (HTA) field in evaluating omics technologies, with a particular focus on the adoption and application of specific assessment frameworks.

We conducted a global survey to gather insights into current practices and frameworks used in HTA evaluations of omics technologies.

We gathered responses from thirty-nine participants representing organizations across twenty-nine countries and five continents. Among them, 51 percent (n = 20) reported experience in evaluating omics technologies, including multi-omics tests for early disease detection, biomarker-based cancer diagnostics, and advanced genomic sequencing techniques. Only three organizations employed specific assessment frameworks: the Adelaide Health Technology Assessment Agency in Australia, the Netherlands Cancer Institute, and the Andalusian HTA Agency in Spain. These frameworks address key evaluation aspects such as analytical and clinical validity, clinical and personal utility, organizational impact, and ethical, legal, and social implications of omics technologies.

Despite their relevance, the limited adoption of tailored frameworks highlights the need for more structured and context-specific approaches to facilitate the integration of omics technologies into healthcare systems. Collaborative efforts among stakeholders, including patients, healthcare providers, policymakers, and industry representatives, are crucial for devising robust evaluation strategies addressing the complexities of omics technologies comprehensively.

This study’s primary objective was to test the feasibility of using the online personal utility function (OPUF) approach and develop a preliminary utility tariff for the EQ-5D-5L based on a South African community sample.

The need for an ethnically and socioeconomically diverse sample was seen as essential. This led to the need for interviewer assistance during completion of the survey instrument and translation of the instrument into multiple languages. English, Zulu, Tswana, and Afrikaans were chosen to allow the vast majority of a community sample people to participate. A sample size of sixty respondents was based on a previous OPUF pilot valuation study for the EQ-5D-5L, and a pilot study of twenty respondents was undertaken using the English language version of OPUF.

There were sixty-one respondents in the main study with most respondent characteristics being well matched with national figures, except for language. Personal utility functions could be calculated for sixty respondents, with the mean tariff showing monotonically declining utility decrements within each dimension. An examination of individual functions showed two contrasting sets of preferences that were driven by the respondents’ rating of death. A separate subgroup analysis also showed preference heterogeneity based on the home language of the respondents.

Our study showed that the application of the OPUF approach is possible in a socioeconomically diverse population in South Africa. The examination of individual personal utility functions shows marked heterogeneity of preferences that needs to be explored further so that the source of this can be established.

The reimbursement of, and subsequent patient access to, high-risk medical devices (MD) and in vitro diagnostics (IVD) across Europe often vary. The Health Technology Assessment Regulation (HTAR) aims to standardize clinical evaluations through Joint Clinical Assessments. Still, national differences in reimbursement frameworks and evidence integration for MD/IVD may impede the realization of HTAR’s expected benefits. This review aims to map existing reimbursement frameworks for high-risk MD/IVD, identify key oversight structures, and evaluate the use of comparative effectiveness and safety evidence in reimbursement decisions across the EU/EEA/UK.

A scoping review was conducted according to the registered protocol (osf.io/65bdk) and was reported following the PRISMA-ScR guidelines. Results were validated through direct engagement with national organizations.

Reimbursement frameworks across the EU/EEA/UK for MD/IVD vary significantly. Of the thirty-four countries reviewed, twenty-three incorporate HTA for MD/IVD reimbursement decisions; of these, only eleven countries have a formal HTA process as part of reimbursement pathways. Eight countries have structured mechanisms to address safety and effectiveness evidence uncertainty. Furthermore, twelve countries have primarily centralized processes, while six rely on regional or local decision-making.

This review highlights the variations in how countries integrate HTA into reimbursement frameworks for MD/IVD, how the national decisions are implemented, and how the evidence uncertainty is assessed. Some countries have a well-established reimbursement framework with formal HTA components, whereas others rely on ad hoc HTA processes. Understanding these differences can help optimize the use of HTAR-generated evidence. Further research is needed to capture ongoing reforms in response to the HTAR.

Under the Universal Health Care Act of the Philippines, all health technologies should undergo health technology assessment. This manuscript details the process of the development of the Philippine guidance document for the use of real-world evidence (RWE) in the clinical evaluation of health technologies.

This study consisted of two phases. Phase 1 was a comprehensive, systematic review of all available HTA methods guides and literature related to the use of RWE in the clinical evaluation of health technologies. Based on the results of the review, a draft HTA methods guide on the use of RWE was created. Phase 2 was a validation study by expert consultation through key informant interviews (KIIs), and pilot assessment of the methods guide.

Seventy-nine articles and nine guidance papers were included, with pertinent information extracted and organized into sections. The first draft covered definitions of RWE, guidance for RWE utilization, scoping and selecting RWE, critical appraisal, data extraction, and synthesis and analysis of RWE. Changes were made to this draft based on the KIIs and pilot assessment results to produce the final output of the methods guide.

This document describes the process of creating a Philippine guidance document that covers the definition of RWE and the appropriate methods for conducting systematic search, screening, critical appraisal, data extraction, data analysis, and synthesis of RWE.

The healthcare system accounts for 4 percent of United Kingdom (UK) greenhouse gas (GHG) emissions annually. In response to climate change, the National Health Service (NHS) is calling for less carbon-intensive care practices through prevention. Respiratory Syncytial Virus (RSV), a leading cause of infant hospitalization, currently has no widespread immunization program in the UK. This study estimates the impact on GHG emissions generated within the care pathway from an immunization against RSV in all infants in the UK with nirsevimab, a new monoclonal antibody used in prophylaxis.

A novel approach was applied, mapping care pathway emissions from immunization and avoiding RSV-related primary and secondary care burden. Avoided healthcare resources were estimated using a published health economic model for nirsevimab versus standard of care (SoC), which is characterized as receiving palivizumab or having no immunization intervention, assuming different universal immunization scenarios. NHS England GHG emission factors were applied to each health outcome to measure the GHG emissions associated with a nirsevimab versus SoC strategy.

Compared with SoC, a universal immunization program using nirsevimab leads to avoided GHG emissions, amounting to ~22 kilotons of CO2 equivalents per year, with immunizing all UK infants at birth leading to the greatest reduction. About 40 percent of avoided emissions were from reductions in inpatient hospitalizations.

This study shows how prevention can deliver benefits to people, NHS system capacity, and the environment. However, avoided patient care pathway emissions must be considered alongside drug lifecycle emissions, which are not included here.

Horizon scanning (HS) is a methodology that aims to capture signals and trends that highlight future opportunities and challenges. The National Institute for Health and Care Research (NIHR) Innovation Observatory routinely scans for medical technologies and therapeutics to inform policy and practice for healthcare in the United Kingdom (UK). To date, there is no standardized terminology for horizon scanning in healthcare. Here, we discuss the development of a data glossary and the IOAtlas web app.

We extracted data points from 4 years’ worth of NIHR Innovation Observatory HS projects and collated them by technology type and descriptive family. A source repository was established by extracting a list of all sources used in NIHR Innovation Observatory briefing notes between 2017 and 2021. The repository was validated by external HS organizations and experts, and sources were then mapped to the appropriate time horizons. The glossary and repository were converted to an SQLite database format and connected to a free web app, IOAtlas.

After de-duplication and consolidation, a total of 148 data points were included in the glossary. The source repository consists of 149 sources, with 99 percent being compliant with searching for two or more technology types. The final SQLite database contained 35 tables with 36 relationships.

We present a data glossary to provide globalized standardization for the terminology used in HS projects. The glossary can be accessed through the IOAtlas web app. Furthermore, we provide users with an interface to generate downloadable data extraction templates within IOAtlas.

The increasing relevance of horizon scanning (HS), early awareness (EA), and disinvestment (DIS) highlights the need for a structured approach to capacity building. Although these fields are essential for evidence-based policy decisions, a harmonized education and training framework to develop necessary competencies is lacking. This article presents the development of a curriculum designed to address this gap in training.

A transdisciplinary working group was established, drawing on international stakeholders from academia, the public sector, and industry. Using an iterative consensus-driven approach, the group developed a modular curriculum. The curriculum design incorporated best practices from existing education programs in related fields and emphasized case-based learning strategies to ensure contextual adaptability.

The resulting curriculum covers theoretical foundations, practical applications, and decision-making processes related to HS, EA, and DIS in eight modules. It supports diverse learner needs, including trainees, training institutions, and public and private organizations, and is designed to be flexible, scalable, and applicable across different regional and organizational contexts.

This curriculum initiative represents a major step toward harmonizing capacity building in HS, EA, and DIS. It fosters sustainability, enhances global health system preparedness, and provides a structured educational platform to support the effective integration of emerging health technologies and evidence-based disinvestment strategies.

Prioritization of health technologies for insurance coverage is usually based on explicit and implicit criteria. This study presents the development of the multi-criteria decision analysis (MCDA) model, the Iranian Health Insurance Benefit Optimization Model (IR-HIBOM), to inform the design of basic health insurance benefit packages.

An initial set of twenty-nine potential allocation criteria was identified through a review of available evidence and other relevant literature. Review of this set by three specialized panels yielded a final set of thirteen criteria. A cross-sectional survey using the best–worst scaling method was then fielded to 163 health system experts to evaluate their preferences regarding the relative importance of the allocation criteria. The mixed logit method was employed to determine the weight of the relative importance of each criterion. Subsequently, a multilevel criteria scoring framework was defined based on a review of similar models and input from a panel of five expert members of the study team. Finally, model’s appraisal was conducted.

Thirteen criteria, including relative safety, efficacy, disease severity, access to alternative health technologies, budget impacts, cost-effectiveness, quality of evidence, population size, age, job absenteeism, economic status, daily care needs, and ease-of-use/acceptance were selected. Cost-effectiveness and ease-of-use criteria had the highest and lowest relative importance weights, with 30.5 percent and 1 percent, respectively. Furthermore, scores were determined for the several levels of each criterion, and decision rules were defined for the cost-effectiveness and budget impact criteria. The final model’s appraisal, based on weighted scores of thirteen selected technologies, indicated that it was valid and applicable.

The IR-HIBOM demonstrated its potential utility in the health resource allocation.