Mere gatekeepers or shapers? Health technology assessment (HTA) is increasingly facing the challenge of transcending its traditional role in evaluating new drugs, devices, or tests to become a more proactive catalyst for the transformation of health systems, actively influencing their shape. This topic was the subject of the plenary session "Next-Generation HTA: Embracing Change to Meet Global Demands," held at HTAi 2025, the global summit bringing together more than 800 key players in the field of HTA in Buenos Aires.
Opening the session, the Dr. Andrés Pichon Riviere, director general of IECS, stated that HTAs focused primarily on the incremental analysis of new technologies may not be sufficient to generate significant changes in our health systems.
“Even in high-income countries, we see persistent gaps in disease prevention, detection, and management, and poor outcomes in cancer and mental health care. Therefore, HTA is a powerful tool, but could it be used more ambitiously? Perhaps HTA should focus more on improving the implementation of interventions we already know are effective, rather than primarily concentrating on identifying and evaluating new technologies that might be effective,” posited Dr. Pichon Riviere.
Another moderator, the Dr. Wija Oortwijn, a lecturer in HTA at Radboud University Medical Center in Nijmegen, the Netherlands, argued that HTAs must continue to evolve based on factors such as the emergence of new therapies, digital health technologies, changing societal preferences, and methodological developments, but without losing sight of the fact that their objective remains unchanged: to inform decision-making by determining the value of health technologies. “My view is that before we move toward further expansion [of our role], we must perform our current function effectively and efficiently,” he summarized.
Four panelists contributed their perspectives. Saudamini Dabak, head of the International Unit of Thailand's Health Interventions and Technology Assessment Program (HITAP), stated that HTA “needs to be agile and adaptable to respond meaningfully to the needs of different health systems.” She called for staying ahead of the trends that are drastically shaping and transforming our society globally, including precision medicine, digital health, artificial intelligence, and Big Data. “This may involve creating or implementing methodological innovations, but it also requires us to think about the processes and guidance we can provide so that the system is ready to effectively adopt these technologies,” she added.
The health economist Anna Vassall, director of the Economic Evaluation and Analysis Unit of the World Health Organization (WHO) and professor at the London School of Hygiene and Tropical Medicine, noted that there is a "moral imperative" to examine how resources are allocated in low-income countries, because it translates into millions of lives that could be saved. And that HTA has served as a "guiding framework" for prioritizing technologies and other interventions, so the changes being advocated today have largely already been made.
Dr. Mairin Ryan, Director of HTA at the Health Information and Quality Authority (HIQA) in Ireland, asserted the “unique place” that HTA occupies within the healthcare system. “HTA is the area where we evaluate new technologies and interventions. We do this systematically, transparently, consistently, and without bias. We try to ensure, at the very least, that it is free from other influences, such as political expediency, short-term political objectives, and conflicts of interest. Therefore, I believe it is essential that we maintain our position as independent evaluators of the best available evidence. This is crucial to maintaining the confidence of decision-makers, but also of patients and the public, in the results we achieve and in the key role we play in the healthcare system,” she maintained.
Ryan added that, beyond the traditional focus on efficacy, safety, and cost-effectiveness, there is room to consider other areas or domains of HTA in greater depth. “For example, the organizational domains, which are really important for implementation; the patient and social domains, to identify what matters most to patients; and also the ethical domains, which are crucial for identifying how we can implement interventions that maximize equity and dignity,” he listed.
Christoph Glaetzer, Director of Global Value and Access at Johnson & Johnson Innovative Medicine in the United States, questioned the existence of new treatment modalities and options that are evaluated using methodologies developed 30 years ago. “We need to adapt. There are HTA systems that place a higher value on early and predictable death, rather than living longer, but perhaps with uncertainty about how long. That's wrong. That needs to change. There are still healthcare systems that use a 30-year-old threshold [for their HTAs]. That needs to be updated,” he remarked.