Hospital-Based Health Technology Assessment (HB-HTA) is a heterogeneous phenomenon constantly evolving to respond to the needs of decision-makers at the hospital level. In 2023, The HB-HTA Interest Group of Health Technology Assessment International (HTAi) surveyed HB-HTA activities with the aim to provide an updated description of the actual scenario.

An online survey was conducted to gather data on the main characteristics of hospitals, HB-HTA activities, outputs, role in the decision-making processes, dissemination and training activities, and their interaction and collaboration with other stakeholders and HTA-related regulations. Finally, the survey collected feedback on the perception of and current barriers to HB-HTA. Three categories of responders were identified: Both hospitals performing and not performing HTA and policymakers.

Eighty-seven responses were collected from twenty-eight countries. Nearly half of the responders (n = 41) conducted HB-HTA, whereas eighteen consisted of hospitals not performing HTA, and twenty-eight were policy makers. HB-HTA was performed mainly in hospitals with >500 beds. HB-HTA units were organized in 40 percent of cases as an “independent group.” The survey showed that HTA units could contribute to all the steps of the decision-making processes, whereas the impact of the assessments on the decisions was mainly perceived as a medium. Furthermore, HB-HTA was not seen as a duplication of effort, even without specific regulations.

The survey highlighted the role of HB-HTA in hospital decision-making supporting the vision of HB-HTA as one of the actors in the HTA ecosystem, the success of which depends on collaboration with other stakeholders.

The adoption and development of health technology assessment (HTA) in the hospital setting (HB-HTA) differs among countries, but in all cases, it encounters barriers and facilitators. An analysis was conducted to promote international cooperation to develop strategies both to enforce common facilitators and overcome common barriers. HTA specialists from seven countries (at least two per country) contribute to the study.

HTA experts from countries in Western Europe (three), Central and Eastern Europe (three), and Central Asia (one) voluntarily participated in the project. They provided a description of the scenario that HB-HTA faces in their country, then a two-round Delphi study was conducted. The survey was based on twelve statements that were categorized into external and internal barriers and external and internal facilitators. Next, panel experts ranked statements on a seven-point Likert scale with a median agreement score greater than or equal to six and an interquartile range (IQR) greater than or equal to one accepted as reaching consensus. The goal was to identify similarities and differences in the HB-HTA scenarios among countries.

Fifteen experts from France, Hungary, Italy, Kazakhstan, Poland, Switzerland, and Ukraine contributed to the analysis. Among the twelve statements, six were ranked as reaching consensus (two barriers, four facilitators). One external and one internal barrier, which reached consensus, were (i) lack of formal recognition of the role of HB-HTA in national/regional legislations and (ii) limited human resources. Two external facilitators were (iii) creation of a network among hospitals performing HB-HTA and (iv) dissemination of HB-HTA methods and activities, while two internal facilitators were (v) top hospital management support in evidence-based decision-making and (vi) training initiatives dedicated to HB-HTA.

The analysis showed a consensus on the barriers and facilitators for HB-HTA. This creates the opportunity for internationally developed strategies to enforce facilitators and support the adoption and sustainability of HB-HTA. Future research should extend the analysis to other countries and include the results of the HB-HTA survey conducted in 2023 by the HB-HTA Interest Group.

Hospital-based health technology assessment (HB-HTA) is evolving constantly. In 2023, a survey was conducted by the HB-HTA Interest Group of Health Technology Assessment International with the aim of collecting data on HB-HTA activities, including perceptions of the role of, potential for, and barriers to HB-HTA. Overall, 87 responses were collected: 41 from hospitals performing health technology assessment (HTA), 18 from hospitals not conducting HTA, and 28 from policymakers.

The survey collected data from 28 countries. Italy, Poland, Brazil provided the highest number of responses. We conducted a descriptive comparative analysis focusing on these three countries to investigate whether and how the policies for HB-HTA, the activities of HB-HTA, and the perceptions of HB-HTA differed among policymakers and hospitals not performing HTA.

Overall, 19 responses were collected from Italy and 10 each were collected from Brazil and Poland. While Italy (n=10) and Brazil (n=8) had a high number of responses from hospitals performing HB-HTA, most of the responses from Poland (n=9) were from hospitals not performing HTA. There was a lack of policies for HB-HTA in all three countries. HTA was performed in big hospitals (≥500 beds) in Italy and Brazil. HB-HTA covered all kinds of technologies, including digital health. In Poland, hospitals not conducting HTA recognized the ability of HB-HTA to promote cost containment. Policymakers were open to including HB-HTA in their activities.

Interpreting the diffusion of HB-HTA, its integration with other HTA processes, and the perceptions of its pros and cons should be both country specific and be conducted from an international perspective. The analysis demonstrated the need for specific policies and for better dissemination and promotion of HB-HTA activities and collaborations with HTA agencies.