International Decisions Research Articles

A CT-based diagnostic nomogram and survival analysis for differentiating grade 3 pancreatic neuroendocrine tumors from pancreatic ductal adenocarcinomas.

To construct a CT-based diagnostic nomogram for distinguishing grade 3 pancreatic neuroendocrine tumors (G3 PNETs) from pancreatic ductal adenocarcinomas (PDACs) and assess their respective survival outcomes. Patients diagnosed with G3 PNETs (n = 30) and PDACs (n = 78) through surgery or biopsy from two medical centers were retrospectively identified. Demographic and radiological information, including age, gender, tumor diameter, shape, margin, dilatation of pancreatic duct, and invasive behavior, were carefully collected. A nomogram was established after univariate and multivariate logistic regression analyses. The Kaplan-Meier survival was performed to analyze their survival outcomes. Factors with a p-value <0.05, including age, CA 19-9, pancreatic duct dilatation, irregular shape, ill-defined margin, pancreatic atrophy, combined pancreatitis, arterial/portal enhancement ratio, were included in the multivariate logistic analysis. The independent predictive factors, including age (OR, 0.91; 95% CI, 0.85-0.98), pancreatic duct dilatation (OR, 0.064; 95% CI, 0.01-0.32), and portal enhancement ratio (OR, 1,178.08; 95% CI, 5.96-232,681.2) were determined to develop a nomogram. The internal calibration curve and decision curve analysis demonstrate that the nomogram exhibits good consistency and discriminative capacity in distinguishing G3 PNETs from PDACs. Patients diagnosed with G3 PNETs exhibited considerably better overall survival outcomes compared to those diagnosed with PDACs (median survival months, 42 vs. 9 months, p < 0.001). The nomogram model based on age, pancreatic duct dilatation, and portal enhancement ratio demonstrates good accuracy and discriminative ability effectively predicting the probability of G3 PNETs from PDACs. Furthermore, patients with G3 PNETs exhibit better prognosis than PDACs.

The impact of social media engagement on enrolment intention: The moderating role of the student type

Potential international students use social media platforms to acquire important information about schools and their brand reputations while making international higher education decisions. By means of a cross-sectional data from 384 international students at three universities in North Cyprus, the study aims to explore the relationship between social media engagement, information credibility and enrolment intention. Furthermore, if information credibility works as a mediator between social media engagement and enrollment intention, and the moderating role of student type. The study makes several contributions to the literature review and its recommendation helps top management at universities and policy makers in North Cyprus to pay attention to the role of social media in recruiting international students. The findings of this study indicate that credibility fully mediates the relationship between social media engagement and enrollment intention, but student type doesn’t moderate the relationship between information credibility and enrollment intention. The limitations and future studies are discussed in this study.

Dynamic Monitoring Mechanism for Management Accounting and ESG Compliance Based on Intelligent Analytics

Abstract The world economy is rapidly developing, leading to constant updates and iterations in the environment, technology, and products, thereby exposing many companies to financial risks. Management accounting and ESG theory, as internal decision support tools, play a role in creating value and improving performance in enterprises. The article examines the functions of management accounting and ESG theories in dynamic monitoring mechanisms, based on basic research. Analyzing and predicting the financial status of Chinese A-share listed companies in 2020-2022 is achieved by proposing research hypotheses and designing measurement models and financial risk prediction models. The results show that management accounting and ESG compliance are important parts of the dynamic monitoring system. Because of this, big data statistics need to be used regularly to summarize, analyze, and find the root causes of problems found in the monitoring process and suggest solutions.

A situational and stakeholder analysis of health technology assessment in Zimbabwe.

Systematic priority setting is necessary for achieving high-quality healthcare using limited resources in low- and middle-income countries. Health technology assessment (HTA) is a tool that can be used for systematic priority setting. The objective of this study was to conduct a stakeholder and situational analysis of HTA in Zimbabwe. We identified and analyzed stakeholders using the International Decision Support Initiative checklist. The identified stakeholders were invited to an HTA workshop convened at the University of Zimbabwe. We used an existing HTA situational analysis questionnaire to ask for participants' views on the need, demand, and supply of HTA. A follow-up survey was done among representatives of stakeholder organizations that failed to attend the workshop. We reviewed two health policy documents relevant to the HTA. Qualitative data from the survey and document review were analyzed using thematic analysis. Forty-eight organizations were identified as stakeholders for HTA in Zimbabwe. A total of 41 respondents from these stakeholder organizations participated in the survey. Respondents highlighted that the HTA was needed for transparent decision making. The demand for HTA-related evidence was high except for the health economic and ethics dimensions, perhaps reflecting a lack of awareness. Ministry of Health was listed as a major supplier of HTA data. There is no formal HTA agency in the Zimbabwe healthcare system. Various institutions make decisions on prioritization, procurement, and coverage of health services. The activities undertaken by these organizations provide context for the institutionalization of HTA in Zimbabwe.

공적개발원조(ODA) 수원체계에 대한 연구

Purpose: This paper analyzes the ODA management system, including the internal communication system, partnership structure, and policy decision-making and implementation process, of Lao PDR, Indonesia and Vietnam, which are Korea’s key partner countries in Asia. Based on the analysis, the paper aims to draw policy recommendations for donors to enhance aid effectiveness. Originality: This study analyzes recipient countries’ ODA management system from aid effectiveness perspective, which is relatively understudied compared to donors’ aid management system. It specifies the scope of aid management system by developing a new analytical framework based on the four elements consisting of legalization and legislation, key implementing agencies, communciation and partnership, and monitoring and evaluation process. Methodology: The study conducts literature review on the relationship between aid effectiveness and recipient countries’ governance. Based on the analytical framework, case studies on Korea’s three key aid recipient countries, i.e. Lao PDR, Indonesia, and Vietnam are conducted. The study utilizes official government documents and academic literature, and incorporates feedback from experts. Result: Although the three countries had different aid management systems, following similarities were found: mid-long term national development strategies having close linkage to the aid management system; recipient countries strengthening governance and institutional basis for enhanced ownership and transparency; while the role and capacity of key implementing agencies leading to different types of aid inefficiency issues. This implies that ODA management system has direct impact on aid efficiency and effectiveness. Conclusion and Implication: The study shows the importance of donors’ approach to recipient countries based on the latter’s context. Also, in-depth understanding of recipient countries’ aid management system can help donors better identify potential areas of cooperation and design new projects through ODA. The same applies to Korea, which is a key donor in all three country cases.

중국 기업의 가상 브랜드 커뮤니티 분위기가 소비자 가치공동 창출 행위에 미치는 영향

Purpose - This study is based on the Theory of Planned Behavior and aims to explore the decision-making mechanisms of consumers participating in value co-creation activities within virtual brand communities.&#x0D; Methodology - The research involved a comprehensive survey of 405 participants from various virtual brand communities. Structural Equation Modeling (SEM) was used for data analysis, applying SPSS and AMOS to test the hypotheses. The study focused on community rules and regulations, community experience and community trust.&#x0D; Results - The research found that community rules and regulations significantly impact subjective norms and perceived behavioral control, but not directly influence consumer attitudes. Community experience positively affected consumer attitudes, subjective norms and perceived behavioral control. Community trust was found to positively influence these aspects of consumer decision-making. However, a gap was identified in the direct influence of perceived behavioral control on actual consumer behavior.&#x0D; Implications - The findings of this study contribute to a more comprehensive understanding of factors affecting consumer behavior in virtual brand communities. It underscores the necessity for community managers to develop strategies that consider these internal decision-making mechanisms, facilitating more effective community engagement. The study also identifies a potential area for future research in the direct influence of perceived behavioral control on actual consumer behavior.

International Partnerships to Develop Evidence-informed Priority Setting Institutions: Ten Years of Experience from the International Decision Support Initiative (iDSI)

ABSTRACT All health systems must set priorities. Evidence-informed priority-setting (EIPS) is a specific form of systematic priority-setting which involves explicit consideration of evidence to determine the healthcare interventions to be provided. The international Decision Support Initiative (iDSI) was established in 2013 as a collaborative platform to catalyze faster progress on EIPS, particularly in low- and middle-income countries. This article summarizes the successes, challenges, and lessons learned from ten years of iDSI partnering with countries to develop EIPS institutions and processes. This is a thematic documentary analysis, structured by iDSI’s theory of change, extracting successes, challenges, and lessons from three external evaluations and 19 internal reports to funders. We identified three phases of iDSI’s work—inception (2013–15), scale-up (2016–2019), and focus on Africa (2019–2023). iDSI has established a global platform for coordinating EIPS, advanced the field, and supported regional networks in Asia and Africa. It has facilitated progress in securing high-level commitment to EIPS, strengthened EIPS institutions, and developed capacity for health technology assessments. This has resulted in improved decisions on service provision, procurement, and clinical care. Major lessons learned include the importance of sustained political will to develop EIPS; a clear EIPS mandate; inclusive governance structures appropriate to health financing context; politically sensitive and country-led support to EIPS, taking advantage of policy windows for EIPS reforms; regional networks for peer support and long-term sustainability; utilization of context appropriate methods such as adaptive HTA; and crucially, donor-funded global health initiatives supporting and integrating with national EIPS systems, not undermining them.

Comparative Research on the Internationalized Business Strategies of China and U.S. Multinational E-commerce Companies

This paper conducts comparative research on the internationalized business strategies of Chinese and U.S. multinational technology companies, with a specific focus on E-commerce. It begins by examining the global macroeconomic context, including features of the world economy and the opportunities and challenges faced by multinational tech companies in their international operations. It then assesses the global competitiveness of Chinese and U.S. e-commerce industries through international market share analysis, trade competitiveness indices, and revealed comparative advantage indices. Subsequently, a comparative analysis is conducted for two multinational tech giants, Alibaba and Amazon, considering their management capabilities, financial performance, investment outcomes, and growth potential. The aim of this paper is to enhance understanding of the internationalization strategies of Chinese and American e-commerce firms, their competitive standings, and provide insights for future international business decisions in the e-commerce sector.

Decisions of international commercial arbitration as an object of review by a court of civil jurisdiction

The article is devoted to the analysis of the content and features of the international commercial arbitration decision. Attention is focused on the specified procedural document as the object of review by the judicial authority. At the same time, the relevance of the chosen topic for coverage in the scientific article is determined based on the data of judicial statistics and the importance of acquiring the finality by the decisions of the international commercial arbitration. From this point of view, the author analyzes the procedure of acquiring legal force and finality both of the decisions of the international commercial arbitration and of the judicial act of the appellate instance, which is adopted based on the results of the review of the arbitration decision.&#x0D; Given the properties of the court decision, the work draws attention to the enforceability of the international commercial arbitration decision and other signs, the presence of which indicates the legal force and binding nature of the specified procedural document. In addition, a question is raised about the possibility of supplementing the objects of review by a court of civil jurisdiction of additional procedural documents of international commercial arbitration. In connection with this, the subject of consideration in the work is the types of decisions of international commercial arbitration and the requirements that such acts must meet. The review of the decisions of the specified arbitration by the court of appeal of civil jurisdiction is differentiated from the activity of the latter to review the decisions of the local court in the appellate procedure according to the rules of the Civil Procedure Code of Ukraine. Attention is drawn to the complete lack of level arrangement when applying to a judicial authority with a appeal to cancel an international commercial arbitration decision.&#x0D; The conclusions note the need to improve the civil procedural legislation and international commercial arbitration in relation to the optimization of the objects of review of acts of the specified body. Along with this, the author does not support the proposal expressed in the scientific literature regarding the change of court jurisdiction for reviewing the decision of international commercial arbitration.

Implementing Decisions on Environmental Conflicts Beyond the Nation State

This article theorises the national implementation of European and international decisions on environmental conflicts, integrating both judgments from courts and so-called managerial decisions from (non-)compliance mechanisms in multilateral environmental agreements. Starting from the observation that the impact of climate change is increasing with backlash from populist governments and political regimes against its mitigation, implementing legal obligations in the absence of specialised environmental courts is crucial to protect the environment from harm. However, systematic insights on the national implementation of judgments and managerial decisions made beyond the nation state are underexplored. Following a political science perspective, this article conceptualises the conditions explaining this phenomenon by making use of existing research from various disciplines including political science and law on policy implementation to enable systematic comparisons. For this purpose, the article outlines a concept structural approach based on two hypothesised explanations: one based on the mechanisms used to solve conflicts, and another relating to the legitimacy of relevant institutions and processes of conflict resolution. These explanatory pathways reflect the existing management and enforcement approaches from the political science literature on implementation and follow a conjunctural logic. The theoretical approach developed in this article enables systematic comparisons across decisions and thus accounts for a variety of separate but equally valid explanations. Future research and empirical analysis will directly feed back into the concept structure for further theoretical development and lead to generalisable insights on the national implementation of court judgments and managerial decisions on environmental conflicts. In this way, the aim is to contribute to both political science and legal literature regarding European and international environmental law, environmental politics, and judicial governance.

Peran Pustakawan Dalam Meningkatkan Layanan Informasi di Perpustakaan FEB Universitas Negeri Padang

User satisfaction can be achieved if the library provides good quality service. Therefore, libraries must focus on user satisfaction. To be able to find out the services that users want, need and expect, it is necessary to conduct research on users. This is done so that there is no difference in perception regarding what the library provides to users and what users actually want and need. Based on the problems above, the research aims to analyze the quality of services provided by the Padang State University FEB Library using the ServQual method. In the ServQual model, the user's perception of the service received (perceived service) is the result of a series of internal company decisions and activities. The quality of service provided by Padang State University FEB Library still cannot satisfy customers. This can be seen from the negative gap value of the ServQual score. Of the 23 service attributes, there are 13 attributes that have a negative value that cannot be accepted by users and 10 attributes that can still be tolerated by users.

Eliciting Exploratory Patient Preference Data: A Case Study in a Rare Disease.

Qualitative and quantitative methods provide different and complementary insights into patients' preferences for treatment. The aim of this study was to use a novel, mixed-methods approach employing qualitative and quantitative approaches to generate preliminary insights into patient preferences for the treatment of a rare disease-generalized myasthenia gravis (gMG). We conducted a mixed-methods study to collect exploratory qualitative and quantitative patient preference information and generate informative results within a condensed timeline (about 4 months). Recruitment was facilitated by an international health research firm. Study participants first reviewed a brief document describing six treatment attributes (to facilitate more efficient review of the material during the focus groups) and were then provided a link to complete an online quantitative survey with a single risk threshold task. They then participated in online focus groups, during which they discussed qualitative questions about their experience with gMG treatment and completed up to three quantitative threshold tasks, the first of which repeated the threshold task from the online survey. The study elicited both quantitative data on 18 participants' risk tolerance and qualitative data on their treatment experience, additional treatment attributes of importance, the reasoning behind their preferences, and the trade-offs they were willing to make. Most participants (n=15) chose the same hypothetical treatment in the first threshold task in the online survey and the focus groups. Focus group discussions provided insights into participants' choices in the threshold tasks, confirmed that all the attributes were relevant, and helped clarify what was important about the attributes. Patient preference information can be collected using a variety of approaches, both qualitative and quantitative, tailored to fit the research needs of a study. The novel mixed-methods approach employed in this study efficiently captured patient preference data that were informative for exploratory research, internal decision making, and future research.

Challenges of Legal Guarantees for the Enforcement of Arbitral Awards in International Commercial Cases

Background: The historical determinants of the appearance of international arbitration correspond to the general tendency of the complication of legal relations of highly developed civilisations, where business processes are its drivers. It is expected that a complex transnational business layered on different levels of civilisation is characterised by an increase in the probability of misunderstandings regarding the proper fulfilment of obligations, the resolution of which is referred to as international arbitration, which, by nature, is more effective than national courts. In this regard, within legal doctrine and among legal practitioners, there is an ongoing discourse on strategies to mitigate risks associated with the execution of international arbitration decisions and related issues. Methods: The research employed a methodological toolkit encompassing formal and dialectical logic, a synergistic methodological approach. The primary method within this framework was the synergistic analysis of the transformation of formal-legal sources and the corresponding application practices. Additional methods included historical-legal, comparative-legal, formal-dogmatic methods and contextual analysis. Results and Conclusions: Formal-legal guarantees for the execution of international arbitration decisions represent a system of requirements governing the procedural and actual actions of state- authorised persons (bodies) that ultimately lead to such execution. The basis of such guarantees is the adequacy of the subject to which the method is applied. Firstly, the arbitrators must make the decision. Secondly, this concerns a property (commercial) dispute. Thirdly and fourthly, enforcement of arbitral awards made in the territory of a State other than the State where the recognition and enforcement of such awards are sought and arising out of differences between persons, whether physical or legal. These signs follow from the corresponding specific acts of private international law. The enforceability of an arbitral award depends on the timely and appropriate actions of the parties to the contract. Even during the negotiation of a foreign economic agreement, the result of an audit of the business partner’s reliability in terms of its ability to fulfil its financial and/or other obligations properly should be obtained.

A METHOD FOR EVALUATING EXPLANATIONS IN AN ARTIFICIAL INTELLIGENCE SYSTEM USING POSSIBILITY THEORY

The subject of the research is the process of generating explanations for the decision of an artificial intelligence system. Explanations are used to help the user understand the process of reaching the result and to be able to use an intelligent information system more effectively to make practical decisions for him or her. The purpose of this paper is to develop a method for evaluating explanations taking into account differences in input data and the corresponding decision of an artificial intelligence system. The solution of this problem makes it possible to evaluate the relevance of the explanation for the internal decision-making mechanism in an intelligent information system, regardless of the user's level of knowledge about the peculiarities of making and using such a decision. To achieve this goal, the following tasks are solved: structuring the evaluation of explanations depending on their level of detail, taking into account their compliance with the decision-making process in an intelligent system and the level of perception of the user of such a system; developing a method for evaluating explanations based on their compliance with the decision-making process in an intelligent system. Conclusions. The article structures the evaluation of explanations according to their level of detail. The levels of associative dependencies, precedents, causal dependencies and interactive dependencies are identified, which determine different levels of detail of explanations. It is shown that the associative and causal levels of detail of explanations can be assessed using numerical, probabilistic, or possibilistic indicators. The precedent and interactive levels require a subjective assessment based on a survey of users of the artificial intelligence system. The article develops a method for the possible assessment of the relevance of explanations for the decision-making process in an intelligent system, taking into account the dependencies between the input data and the decision of the intelligent system. The method includes the stages of assessing the sensitivity, correctness and complexity of the explanation based on a comparison of the values and quantity of the input data used in the explanation. The method makes it possible to comprehensively evaluate the explanation in terms of resistance to insignificant changes in the input data, relevance of the explanation to the result obtained, and complexity of the explanation calculation. In terms of practical application, the method makes it possible to minimize the number of input variables for the explanation while satisfying the sensitivity constraint of the explanation, which creates conditions for more efficient formation of the interpretation based on the use of a subset of key input variables that have a significant impact on the decision obtained by the intelligent system.

Modeling farmers’ willingness to engage in traceability systems: toward sustainable agricultural transformation

IntroductionThe primary objective of this study is to examine the factors that affect farmers’ willingness to engage in traceability systems. Traceability systems are widely promoted as technologies that ensure the quality and safety of agricultural products. However, the participation rate of farmers in developing countries remains low.MethodsTo empirically address this issue, the study analyzed structured interview data from 408 fruit farmers in Henan Province, Central China, using structural equation modeling and system dynamics.ResultsThe results indicate that attitude, perceived behavioral control, subjective norms, moral norms, and safety awareness are crucial factors influencing farmers’ willingness to engage. It is particularly noteworthy that system dynamics simulations revealed the significant role of improving attitude and subjective norms in promoting farmers’ willingness. Moreover, subjective norms have a positive influence on moral norms. We also found that gender, education, orchard area, income and access to credit have a significant positive impact on farmers’ willingness to engage.DiscussionBy uncovering the internal decision-making mechanisms behind farmers’ engagement in traceability systems, this study extends the research scope of agricultural technology adoption. These findings can serve as a basis for formulating traceability system policies and interventions in China and other developing countries.

Management Accounting in the Malaysian Public Sector: Analysing the Adoption of Financial and Risk Analysis

Purpose: This paper aimed to analyse the introduction of financial analysis and risk management for internal decision-making in the Malaysian public sector and determine the limitations/ gaps as well as areas for improvement. Design/ Methodology/ Approach: The paper was based on the analysis of documents, government circulars and guidelines pertaining to financial statement analysis and risk management, including interviews with officers at two ministries. Findings: Policy and guidelines were established for financial analysis and risk management in the Malaysian public sector. However, given the complexities and unique context of each ministry, there is a need for clearer and more context-specific guidelines regarding financial and risk analysis. It is also crucial that the conducted financial and risk analyses are relevant and meet the specific needs of public sector entities. The usefulness of information relies on a comprehensive understanding of the context and types of decision needed. Therefore, fostering collaboration and engagement between the management accountant unit and other key units within a ministry is crucial to conduct an effective financial and risk analysis. Originality/ Value: This study offered insights into the financial and risk analysis reporting framework and its implementation in the Malaysian public sector. Keywords: Management accounting, public sector accounting, financial statement analysis, risk management, public sector accountants.

PHILOSOPHICAL AND ANTHROPOLOGICAL CONCEPTUALIZATION OF POLITICAL GEOGRAPHY

Actual scientific researches and issues analysis. Philosophical dimensions of space, society, and communities hold great significance today and have been the subject of study by both domestic and Western scholars. This theme has deep roots in philosophy and geography, with initial approaches linking the development of nations and peoples to their territories. These views found expression in geographic determinism, as seen in the works of Montesquieu, and the ideas of “geosophy” by J. K. Wright. The research objective. The primary goal of this study is to provide a philosophical perspective on the complex nature of politics in the context of its interaction with various aspects of the geographical and cultural environment. The statement of basic materials. The anthropological approach to political geography sheds light on the role of sociocultural factors in political processes, including: the influence of cultural values, religious beliefs, traditions, and language policies on political activities. The interplay between culture and politics, particularly in the perception of political candidates and the formation of political identities. The impact of globalization on political geography and the challenges it poses to politics and geopolitics. Globalization affects politics and society by: increasing interdependence among countries and regions. Necessitating adaptation to changes in the global system and the development of effective political strategies. Influencing national political systems through global economics, international trade, and organizations. Contemporary challenges and opportunities include: collaborative international decision-making and addressing global issues, such as climate change and mass migration. The role of the internet and social media in political communication, mobilization of civil society, and the dissemination of political information.

Does audit regulation improve corporate decision making? Evidence from the disclosure of tax‐related key audit matters

AbstractOur study examines changes in corporate cash tax savings around the disclosure of tax‐related key audit matters (tax KAMs). We expect publicly disclosed tax KAMs to increase the visibility of a firm's tax complexity and uncertainty, thereby motivating the firm to improve its tax function. In turn, we expect to observe increased cash tax savings as an outcome of improvements to corporate tax functions. As predicted, we document that firms exhibit lower cash effective tax rates in the period after their auditors disclose tax KAMs. Additional tests suggest that disclosure of tax KAMs does not increase the likelihood of firms being aggressive in cash tax planning and increased cash tax savings are primarily driven by firms that adjust toward their optimal levels of cash tax savings. Cross‐sectional analyses support our expectation that post‐disclosure increases in cash tax savings are less pronounced when investors were better informed about firms’ tax strategies in the pre‐disclosure period and when firms faced stronger tax enforcement in the pre‐disclosure period. Collectively, our results highlight the role of KAM disclosure requirements in prompting firms to improve their internal operational decisions.

Internal Performance Measures and Earnings Management: Evidence from Segment Earnings

ABSTRACT We examine whether the design of a firm’s internal management accounting system is associated with GAAP earnings management. We exploit the fact that ASC 280 mandates a “management approach” requiring multisegment firms to disclose their segment earnings as defined internally by their management accounting system. We posit that the less these segment earnings are decoupled from GAAP earnings, the higher are the costs of earnings management because earnings management spills over to segment earnings and distorts information used for internal decision-making. Thus, we predict that firms with more decoupled segment earnings engage in more earnings management. Using a large sample of U.S. firms from 1998 to 2020, we find support for this prediction. We also find that the decision usefulness of segment earnings for segment investment purposes decreases as earnings management increases, with this association being more pronounced for firms with less decoupled segment earnings measures. Data Availability: Data are available from the public sources cited in the text. JEL Classifications: M41; G14.

PP01 Health Technology Assessment Of Cervical Artificial Disc Replacement: Highlighting The Need For A Consistent International Approach

IntroductionCervical artificial disc replacement (C-ADR) is not a new technology but one that has seen many technological advances in the past 10 years. Indeed, a recent review described total disc arthroplasty as the most innovative development in the history of spinal surgery. The primary goals of C-ADR are to reduce or eliminate pain, and restore normal segmental motion. The aim of this analysis was to identify, extract and examine key health outcomes and economic data from published health technology assessment (HTA) reports on C-ADR, with the aim of understanding how the evolution of this technology has influenced assessments internationally.MethodsA comprehensive search of over 90 HTA organization websites and the INAHTA HTA database using key terms for C-ADR surgical procedures was coupled with a literature search of recent systematic reviews. No language restrictions were applied.ResultsTwenty HTA reports of C-ADR surgery published from 2005 to 2022 were included for review. Several HTAs (4/20) were updates or reassessments by the same agency and one was an update across agencies (Italy update of Belgian HTA). While many of the HTAs concluded C-ADR is as effective as standard care and superior in certain outcomes, there was no pattern or consistency in the conclusions or recommendations from these assessments, even as the evidence base expanded over time. Our analysis found this was largely due to variations in HTA approaches among agencies including: differences in research questions asked, PICO (Population, Intervention, Comparator, Outcomes) criteria and methods performed, such as: rapid versus full systematic reviews; inclusion of economic evaluations and/or budget impact analyses.Indeed, one of the only predictive factors for a positive HTA was a favorable cost-effectiveness analysis.ConclusionsC-ADR is an established technology with extensive HTA investigation internationally. The lack of a consistent approach taken by HTA bodies made prediction of successful HTA outcomes difficult. Future alignment of key evaluation processes and methods may help address current international variations and support consistent decision making on patient access.