Health Technology Assessment Principles Research Articles

Understanding the extent of economic evidence usage for informing policy decisions in the context of India’s national health insurance scheme: Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY)

IntroductionAyushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY) is one of the world’s largest tax-funded insurance schemes. The present study was conducted to understand the decision-making process around the evolution...

Scaling up health technology assessment capacities in selected African countries - A conceivable route ahead.

This study aimed to provide a structured description of the commonalities and differences in healthcare structures across Africa to establish a reliable basis for the health technology assessment (HTA) of nutrition and nutrition interventions. A ranking of current nutrition conditions in the general population of the participating countries was included to gain a better understanding of the factors influencing hospital malnutrition (HMN), which will inform future multi-country research. A questionnaire on the structure of the health systems was distributed among ten African countries. Subsections were included that inquired about the drivers or barriers to using principles of HTA to assess nutritional care. Analysis and ranking of malnutrition data were based on data from the Global Hunger Index report and two poverty indicators used by the World Bank. The health system structure of each country was identified and described, whereas questions about HTA could not always be analyzed due to a lack of adequate in-depth knowledge and skills in most countries. Early experience from some countries demonstrates a conceivable route ahead for African countries in strengthening the capacity for and implementing HTA in accordance with distinct national healthcare contexts and social determinants of health. Problems related to nutritional care represent one of the major priorities in the surveyed countries. A future HMN multi-country study will provide valuable insight into the potential of low-cost primary prevention orientations.

National Health Technology Assessment in Turkiye after a decade: Are key principles followed?

Health technology assessment (HTA) is growing in low- and middle-income countries (LMICs) to ensure optimal use of limited resources. However, the impact of HTAs on decision making in LMICs has been limited. The study aimed to provide an overview of Turkiye's progress since establishing the first HTA agency in 2012. The web sites of three national HTA agencies in Turkiye were searched for HTA guidelines and national HTA reports. The HTA guidelines were assessed by two researchers independently against the key principles of HTA developed by Drummond et al., and the HTA reports against the national guidelines. The study included one HTA guideline and eight national HTA reports. The guideline included very limited technical guidance. Compliance with the principles was poor to moderate, and significant methodological limitations were identified. The reports were inconsistent regarding the scope and the HTA assessment criteria. The link between HTA findings, HTA decision making, and health policies were not clear. The inconsistencies between the reports and the methodological limitations demonstrate the need for national HTA guidelines. Improving the characteristics of the HTA might impact implementation. Among the key issues is transparency regarding priority setting, the HTA process, and decision making. Establishing and adopting national HTA guidelines at international standards is needed. Involving external scientific committees and health economists in the HTA processes might help ensure that the key principles of HTA are followed. The study findings might be helpful for countries that are developing their HTA systems.

Assessing the potential of HTA to inform resource allocation decisions in low-income settings: The case of Malawi.

Health technology assessment (HTA) offers a set of analytical tools to support health systems' decisions about resource allocation. Although there is increasing interest in these tools across the world, including in some middle-income countries, they remain rarely used in low-income countries (LICs). In general, the focus of HTA is narrow, mostly limited to assessments of efficacy and cost-effectiveness. However, the principles of HTA can be used to support a broader series of decisions regarding new health technologies. We examine the potential for this broad use of HTA in LICs, with a focus on Malawi. We develop a framework to classify the main decisions on health technologies within health systems. The framework covers decisions on identifying and prioritizing technologies for detailed assessment, deciding whether to adopt an intervention, assessing alternative investments for implementation and scale-up, and undertaking further research activities. We consider the relevance of the framework to policymakers in Malawi and we use two health technologies as examples to investigate the main barriers and enablers to the use of HTA methods. Although the scarcity of local data, expertise, and other resources could risk limiting the operationalisation of HTA in LICs, we argue that even in highly resource constrained health systems, such as in Malawi, the use of HTA to support a broad range of decisions is feasible and desirable.

PP140 Barriers And Prospects For The Development Of Hospital-Based Health Technology Assessment In Kazakhstan

IntroductionThe experience of implementing a hospital-based health technology assessment (HB-HTA) system in Kazakhstan is currently represented by only one organization, an independent HB-HTA unit established in 2015 in the Medical Center Hospital of the President's Affairs Administration (the Hospital). Despite the demonstrated positive experience of the Hospital, the widespread implementation of the HB-HTA system in Kazakhstan has experienced some barriers that must be considered before further development can occur.MethodsTo determine the barriers to developing and implementing HB-HTA in Kazakhstani hospitals, data from the Hospital's experience were obtained through a survey of Kazakhstan hospitals, conducted on behalf of the Ministry of Health Care. An official response was received from 29 hospitals. During the survey and discussions with hospital staff using the “brainstorming” method, several barriers to the development of HB-HTA in Kazakhstan were identified.ResultsBarriers at the system level included the lack of monitoring of the HB-HTA system at the national and regional levels and a lack of methodological support. Organizational barriers included a critically small number of HTA experts and the need for additional logistical support and funding from hospitals. The subjective factors we attributed to the rejection of the HB-HTA system by hospital management were the underestimation of lost profits and that HTA is a tool for promoting a transparent and open system for making managerial decisions.ConclusionsDespite some barriers, the development of HB-HTA in Kazakhstan is a promising area. The heads of key hospitals in Kazakhstan demonstrated a readiness and understanding of the need to use the principles of health technology assessment and clinical and economic analysis to promote the active transfer and implementation of innovative medical technologies.

The implementation of health technology assessment principles in public decisions concerning orphan drugs.

Over the last few years, the share of public spending for orphan drugs (ODs) has increased in several western countries, raising concern on the exemptions granted to this sector with respect to the implementation of health technology assessment (HTA) principles. The aim of this paper is to shed light on both the HTA criteria adopted and the international agreements implemented in the OD regulation, given the new challenges imposed on western countries by a growing number of therapies for rare diseases. We carried out a literature review to analyse the development of the international debate on the adaptability of HTA criteria for the OD assessment and regulation. The time span lies between January 1990 and May 2018, and the policies considered relate to both market authorization and reimbursement decisions within western countries. We focus specifically on HTA criteria in some of the dimensions included in the Core Model of the European net for HTA (EUnetHTA). OD high prices, the absence of clarity on the possible high revenues realized by the distribution of a new OD outside the national borders, the risk that - once marketed - a new OD can be used to treat common diseases, are all issues that raise concern on OD regulation and have to be carefully monitored by policymakers in the next future. Across western countries, the preferential track granted to ODs in the implementation of HTA principles is not homogeneous, but fragmented and differentiated. The need for common rules at an international level is underlined, with a view to assessing the sustainability of a sector which, due to this regulatory void, can lend itself to producers' strategic and opportunistic behaviours.

ASSESSMENT OF THE EFFECTIVENESS OF PREVENTION PROGRAMS FOR COUNTERMEASURE OF SPREAD OF SOCIALLY IMPORTANT INFECTIONS

Purpose of the study. To evaluate the effectiveness of the prevention programs aimed at the prevention of the spread of socially important infections on example of HIV infection, as well to express it in units permitting the comparison with other fields of health care and to compare with to expenses for the prevention and treatment of sequelae of infection. Materials and methods. Results of the panel study, executed in 2006-2013 in 10 regions of the Russian Federation in HIV infection risk groups (4 waves). The total number of participants is 9891. Study protocol included detailed survey of risk behavior, involvement in prevention programs and HIV testing. Obtained data were used for the assessment of the change of the morbidity rate as a result of prevention and calibration of the dynamic (Markov) model of the effect of the prevention on the length of quality-adjusted life and treatment cost. Expenses for the prevention were estimated from field reports of prevention projects. Results. Programs for the comprehensive prevention of socially important infections, first of all HIV-infections, among injecting drug users result in the significant decrease in HIV incidence. The assessment of the effect of the prevention within framework of the multivariable model shows odds ratio to be of 0.56 (95% CI=0.40-0.78). This relative reduction corresponds to the decline of the absolute incidence from 3.98 per 100 person per year in the group of persons who was not involved in prevention programs (95% CI=3.37-4.69) to 2.22 per 100 person per year (95% CI=1.89-2.62) among participants. Such effect of the prevention leads to the increase in quality-adjusted life-years per each person (QALY=0.23, 95% CI=0.10-0.37), and the saving of budget cost by 226 thousand rubles (95% CI=209,6 - 822,2 thousand rubles). With the use of more pessimistic assumptions in relation to expenses for the prevention and treatment, the cost per quality-adjusted life per year failed to surpass the threshold of society’s willingness to pay for health technology, with demonstrating high cost-effectiveness of investing in the prevention. Conclusion. Programs of the comprehensive prevention of socially important infections in the Russian Federation have significant effectiveness and under most plausible assumptions are cost-saving. For the solution the problem of financing preventive measures it is necessary to apply the same principles of health technology assessment as it is done is the area of drug coverage.

Advanced therapy medicinal products and health technology assessment principles and practices for value-based and sustainable healthcare

BackgroundAdvanced therapy medicinal products (ATMPs) are beginning to reach European markets, and questions are being asked about their value for patients and how healthcare systems should pay for them.ObjectivesTo identify and discuss potential challenges of ATMPs in view of current health technology assessment (HTA) methodology—specifically economic evaluation methods—in Europe as it relates to ATMPs, and to suggest potential solutions to these challenges.MethodsAn Expert Panel reviewed current HTA principles and practices in relation to the specific characteristics of ATMPs.ResultsThree key topics were identified and prioritised for discussion—uncertainty, discounting, and health outcomes and value. The panel discussed that evidence challenges linked to increased uncertainty may be mitigated by collection of follow-on data, use of value of information analysis, and/or outcomes-based contracts. For discount rates, an international, multi-disciplinary forum should be established to consider the economic, social and ethical implications of the choice of rate. Finally, consideration of the feasibility of assessing the value of ATMPs beyond health gain may also be key for decision-making.ConclusionsATMPs face a challenge in demonstrating their value within current HTA frameworks. Consideration of current HTA principles and practices with regards to the specific characteristics of ATMPs and continued dialogue will be key to ensuring appropriate market access.Classification codeI.

STAKEHOLDERS' PERCEPTIONS OF HEALTH TECHNOLOGY ASSESSMENT IN TURKEY.

In April of 2014, the Turkish Ministry of Health held the First Annual Health Technology Assessment (HTA) Meeting in Antalya. The objectives were to understand the perceptions of stakeholders regarding the current status of HTA and document their recommendations and strategies for promoting systematic use of HTA in Turkey. The study was conducted using a qualitative written survey assessing current compliance with the fifteen HTA principles suggested by Drummond et al. (Key principles for the improved conduct of health technology assessments for resource allocation decision. Int J Technol Assess Health Care. 2008;24:244-258) and a qualitative method referred to as the Collective Intelligence Platform®. A total of 216 stakeholders representing academic, public, and the private health sector attended the annual meeting; 178 completed the survey and 183 participated in the Platform. Quantitative Results: Survey participants reported that, although Turkey does not currently fully comply with any of the fifteen HTA principles, there is some compliance with all of them. The overall average score for all fifteen principles was 3.04. Quantitivate Results: Participants recommended a more transparent, independent, and evidence-based policy decision-making system through better coordination of HTA activities, data aggregation, capacity development, and a national HTA core model and framework. Platform participants described the current HTA environment as disjointed and lacking in resources and support from policy-making leaders. Despite the persisting challenges, awareness of the strengths and weaknesses of the current system combined with increasing interaction among Turkish stakeholders and the international HTA community can meaningfully contribute to the continued development and promotion of HTA in Turkey.

Value-based integrated care: Exploring strategies to enhance the uptake of integrated care

There is a growing recognition that implementing integrated service models for people with chronic diseases are an essential strategy to improve outcomes in terms of the Triple Aim goals patients’ experience of care, population health and costs per capita. In New Zealand and other countries, there has been a need for more social investment in health and the promotion of value-based approaches within care systems to achieve this. In this workshop, we will explore approaches that can promote value-based integrated care (VBIC). VBIC can be defined as patients’ achieved outcomes and experience of care in combination with the amount of money spent by providing accessible, comprehensive and coordinated services to a targeted population. Despite the increasing popularity of integrated care, little is known about the experiences with its implementation, and the mechanisms that influence a successful uptake across different clinical, professional, organisational and system boundaries. Recent empirical evidence indicates that trust-based collaboration mechanisms improve the uptake of integrated care in practice. These findings support recent insights that behavioural change techniques (BCT) might be effective strategies to increase the uptake of integrated care. In addition, it is suggested that the absence of an integrated business model is one of the the main reasons why integrated care interventions are not implemented at scale. Several authors suggest that the principles of health technology assessment (HTA) techniques could also be used to implement integrated care in practice. The likelihood of a success is probably improved when both normative BCT and functional HTA implementation strategies are considered. The aim of the workshop is to identify appropriate indicators and techniques that can be used to enhance the implementation of value-based integrated care interventions in practice. The specific objectives of the workshop are as follows: 1. To examine approaches that have sought to utilise value-based strategies to design and implement integrated care; 2. To identify a set of key performance indicators to improve the uptake of integrated care interventions; 3. To identify appropriate (BCT and HTA) techniques to improve the uptake of integrated care interventions.

Value-based integrated care: Exploring strategies to enhance the uptake of integrated care

There is a growing recognition that implementing integrated service models for people with chronic diseases are an essential strategy to improve outcomes in terms of the Triple Aim goals patients’ experience of care, population health and costs per capita. In New Zealand and other countries, there has been a need for more social investment in health and the promotion of value-based approaches within care systems to achieve this. In this workshop, we will explore approaches that can promote value-based integrated care (VBIC). VBIC can be defined as patients’ achieved outcomes and experience of care in combination with the amount of money spent by providing accessible, comprehensive and coordinated services to a targeted population.Despite the increasing popularity of integrated care, little is known about the experiences with its implementation, and the mechanisms that influence a successful uptake across different clinical, professional, organisational and system boundaries. Recent empirical evidence indicates that trust-based collaboration mechanisms improve the uptake of integrated care in practice. These findings support recent insights that behavioural change techniques (BCT) might be effective strategies to increase the uptake of integrated care. In addition, it is suggested that the absence of an integrated business model is one of the the main reasons why integrated care interventions are not implemented at scale. Several authors suggest that the principles of health technology assessment (HTA) techniques could also be used to implement integrated care in practice. The likelihood of a success is probably improved when both normative BCT and functional HTA implementation strategies are considered. The aim of the workshop is to identify appropriate indicators and techniques that can be used to enhance the implementation of value-based integrated care interventions in practice. The specific objectives of the workshop are as follows:1. To examine approaches that have sought to utilise value-based strategies to design and implement integrated care;2. To identify a set of key performance indicators to improve the uptake of integrated care interventions;3. To identify appropriate (BCT and HTA) techniques to improve the uptake of integrated care interventions.

CURRENT IMPLEMENTATION OF HEALTH TECHNOLOGY ASSESSMENT IN HEALTHCARE SYSTEM IN SLOVENIA

The objective of this study was to analyze and present the current state of the implementation of health technology assessment (HTA) in Slovenia, identify its advantages and challenges, as well as potential improvements and developments. The HTA structure and processes were analyzed and comprehensively described according to relevant literature, official documents, and experiences of the author. The important steps in the development and implementation of an HTA system are presented through eight key elements: capacity building; HTA funding; HTA legislation and organizational structure; the scope of HTA implementation; decision criteria; quality, timelines, and transparency of HTA implementation; use of local data; and international collaboration. Based on the current situation, possible further developments are presented. Currently, there is no systematic HTA in Slovenia; however, some basic use of HTA principles can be found in the decision making. The biggest deficiency in the HTA field is the lack of knowledge and systematic implementation. Legislation and guidelines for study appraisals are needed at decision-making levels. HTA principles across health technologies need to be unified along with a central HTA coordination office being set up to lead and establish priorities for HTA work.

OP92 Addressing Challenges Of Implementing A Health Technology Assessment Framework In South Africa

INTRODUCTION:South Africa is in the process of providing comprehensive health insurance to all its citizens, thus paving the pathway for Health Technology Assessment (HTA) to play a significant role in provision of safe and effective healthcare. The National Department of Health (DoH) has a published framework and Health Technology Act and strategies since the 1990s to improve health outcomes, and service and delivery of care. The purpose of this study is to explore challenges faced in the implementation of the framework and policies.METHODS:The study will be based on review and analysis of health technology policies and legislations introduced in South Africa since the 1990s. These documents are available from the DoH archive. The review from this grey literature was supplemented by information collected from a self-completion questionnaire, which was distributed to key stakeholders. Respondents were identified by direct contact with ministries of health and professional bodies, and included health professionals from the public and private healthcare sector, for example, practitioners, experts from hospitals, and industry representatives. The questionnaire addressed issues pertaining to decision making regarding health service delivery and the status of HTA in the country.RESULTS:The framework lays out the strategy to facilitate appropriate utilization of health technologies and includes among others, an HTA section. Fragmented use of HTA or parts thereof has been observed in the public and private health care sector. Furthermore, the respondents pointed out that decisions on health technology can be political, institutional or professionally driven whereas they all agreed that a formal and institutional implementation of HTA would improve healthcare service.CONCLUSIONS:The goal to achieve universal health care provides an excellent window of opportunity for formal use of HTA in policy- and decision-making. However, (i) the inadequate number of trained professionals and education and training opportunities (ii) lack of awareness and understanding of the principles of HTA and its impact on the improvement of health care are among the many challenges faced by the system. It has also been observed that national and regional champions can act as change agents and would have a snowball effect.

Avaliação de tecnologias no Centro Cirúrgico, Recuperação Pós-anestésica e Centro de Material e Esterilização

Introdução: As tecnologias em saúde são essenciais no centro cirúrgico (CC), na recuperação pós-anestésica (RPA) e no centro de material e esterilização(CME). Por isso, há grande pressão para sua incorporação tecnológica, o que demanda alto investimento e elevados custos operacionais. Objetivos:Refletir sobre os conceitos e princípios da avaliação de tecnologias em saúde (ATS) e discutir exemplos de sua aplicação no contexto do CC, da RPA e do CME.Resultados: A metodologia de ATS permite análise dos impactos clínicos, sociais e econômicos da incorporação de tecnologias, buscando melhorar a qualidadede atendimento e a saúde da população. O Ministério da Saúde tem patrocinado diversas iniciativas para difusão dos princípios de ATS que visam subsidiar osgestores para a tomada de decisão em incorporação tecnológica, tanto no âmbito do sistema de saúde quanto nas instituições hospitalares. Conclusão: A equipede enfermagem deve, na tomada de decisões, apropriar-se da metodologia de ATS para análise crítica do real benefício das tecnologias do bloco operatório.Palavras-chave: Avaliação da tecnologia biomédica. Centros cirúrgicos. Esterilização. Período de recuperação da anestesia.

“Whether something cool is good enough”: The role of evidence, sales representatives and nurses' expertise in hospital purchasing decisions

The emphasis on “value” within healthcare institutions has achieved unprecedented priority, particularly around the purchase of medical products and equipment. Health systems and institutions are implementing formal decision-making processes involving clinicians and supply chain professionals to rationalize purchasing and promote cost-effective investment. One particular form of this process is the “Value Analysis” process. Drawing from fieldwork (100 h), interviews (n = 51) and focus groups (n = 4) conducted from January 2012 to October 2014 at 4 acute care hospitals in the western United States, I analyze the ways that committee members constructed and evaluated a case for a product's value. Participants (n = 72) were a purposive sample including nurses, administrators, supply chain and industry professionals. Interpretive phenomenology served as the analytic approach to generating iterative themes. While trying to be evidence-based, Value Analysis committees lacked data related to a product's price or efficacy and relied heavily on local knowledge and expertise. Sales representatives were an integral part of the process, creating interest in the product and providing product information. As vehicles for cost-savings and quality improvement, purchasing committees need unique support that emphasizes local contexts and expertise, while maintaining rigor and minimizing bias. Drawing from participants' experiences, and principles of health technology assessment and economic evaluation, a guiding framework is proposed to support this decision-making.

The principles of Health Technology Assessment in laboratory medicine.

The Health Technology Assessment (HTA) is a multi-professional and multidisciplinary evaluation approach designed to assess health technology in the broadest sense of the term, from its instruments to the rearranging of its organizational structures. It is by now an established methodology at national and international levels that involves several medical disciplines thanks to its versatility. Laboratory medicine is one of these disciplines. Such specialization was subjected, in recent years, to deep changes even from an organizational standpoint, in order to meet the health needs of the population, making them as effective and cost-effective as possible. In this regard, HTA was the tool used to assess implications in different areas.

The expert patient

The European Patients’ Academy (EUPATI) is a pan-European Innovative Medicines Initiative project of 33 organisations, led by the European Patients’ Forum with partners from patient organisations (the European Genetic Alliance,...

INTEGRATING HEALTH TECHNOLOGY ASSESSMENT PRINCIPLES IN FORMULARY MANAGEMENT.

Effective formulary management in healthcare institutions safeguards rational drug use and optimizes health outcomes. We implemented a formulary management program integrating the principles of health technology assessment (HTA) to improve the safe, appropriate, and cost-effective use of medicine in Singapore. A 3-year formulary management program was initiated in 2011 in five public healthcare institutions. This program was managed by a project team comprising HTA researchers. The project team worked with institutional pharmacy and therapeutics (P&T) committees to: (i) develop tools for formulary drug review and decision making; (ii) enhance the HTA knowledge and skills of formulary pharmacists and members of P&T committees; (iii) devise a prioritization framework to overcome resource constraints and time pressure; and (iv) conceptualize and implement a framework to review existing formulary. Tools that facilitate drug request submission, drug review, and decision making were developed for formulary drug inclusion. A systematic framework to review existing formulary was also developed and tested in selected institutions. A competency development plan was rolled out over 2 years to enhance formulary pharmacists' proficiency in systematic literature search and review, meta-analysis, and pharmacoeconomic evaluation. The plan comprised training workshops and on-the-job knowledge transfer between the project team and institutional formulary pharmacists through collaborating on selected drug reviews. A resource guide that consolidated the tools and templates was published to encourage the adoption of best practices in formulary management. Based on the concepts of HTA, we implemented an evidence-based approach to optimize formulary management.

International survey of methods used in health technology assessment (HTA): does practice meet the principles proposed for good research?

International survey of methods used in health technology assessment (HTA): does practice meet the principles proposed for good research? Jennifer M Stephens,1 Bonnie Handke,2 Jalpa A Doshi3 On behalf of the HTA Principles Working Group, part of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) HTA Special Interest Group (SIG)1Pharmerit International, Bethesda, MD, USA; 2Medtronic Neuromodulation, Minneapolis, MN, USA; 3Center for Evidence-Based Practice and Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USAObjective: To describe research methods used internationally in health technology assessment (HTA) and health-care reimbursement policies; compare the survey findings on research methods and processes to published HTA principles; and discuss important issues/trends reported by HTA bodies related to current research methods and applications of the HTA process.Methods: Representatives from HTA bodies worldwide were recruited to complete an online survey consisting of 47 items within four topics: (1) organizational information and process, (2) primary HTA methodologies and importance of attributes, (3) HTA application and dissemination, and (4) quality of HTA, including key issues. Results were presented as a comparison of current HTA practices and research methods to published HTA principles.Results: The survey was completed by 30 respondents representing 16 countries in five major regions, Australia (n = 3), Canada (n = 2), Europe (n = 17), Latin America (n = 2), and the United States (n = 6). The most common methodologies used were systematic review, meta-analysis, and economic modeling. The most common attributes evaluated were effectiveness (more commonly than efficacy), cost-effectiveness, safety, and quality of life. The attributes assessed, relative importance of the attributes, and conformance with HTA principles varied by region/country. Key issues and trends facing HTA bodies included standardizing methods for economic evaluations and grading of evidence, lack of evidence, and data availability for emerging technologies.Conclusion: This is the first international survey to specifically assess the state of HTA research methods. Future efforts should expand the respondent sample to include more emerging markets and update the results of this survey to specifically address additional aspects of research methods in HTA.Keywords: survey, technology assessment, payers, research methods, reimbursement

Role of health technology assessment in the process of implementation of the EU Transparency Directive: relevant experience from Central Eastern European countries

A total of 7 years after the addition of Poland, the Czech Republic and Hungary to the EU, the pricing and reimbursement regulations introduced in these countries are still considered to be not fully compliant with Directive 89/105/EEC, commonly referred to as the ‘Transparency Directive’ (TD). The TD aims to ensure the transparency of the pricing and reimbursement processes for medicinal products established by the member states. Among the most difficult barriers on the way to successful implementation of the TD discussed are meeting the timelines indicated by the TD, the implementation of objective and verifiable criteria for decisions, and the availability of remedies for negative decisions. Health technology assessment (HTA) has been introduced in to the reimbursement systems in Poland, the Czech Republic and Hungary almost simultaneously to their accession to the EU. Even though Central Eastern European (CEE) countries faced similar challenges during the transformation to a democratic system, certain differences in the extent to which HTA principles have been implemented in these countries could be distinguished. Hence, it is thought-provoking to consider the different views of HTA experts on the role of HTA in the adaptation of the TD in the CEE region. The key objective of this article will be to discuss whether the adaptation of HTA principles has supported or only triggered additional challenges in the process of successful implementation of the TD in the CEE region. In particular, the article will discuss whether the introduction of mandatory HTA recommendations or explicit willingness-to-pay threshold would encourage or discourage implementation of the TD. The importance of the independent HTA agency as a condition for successful introduction of the TD will also be debated.