Threats to the value of Health Technology Assessment: Qualitative evidence from Canada and Poland

Background: Health Technology Assessment is used to support the process of drug appraisal and reimbursement decisions in a variety of health systems. Examples can be found in mature Western countries, such as Canada, and in emerging economies of Central and Eastern Europe, such as Poland. The value of HTA in the process is influenced by the evidence used and the stakeholders involved. Methods: Qualitative interviews with 29 members of two appraisal committees were held in Canada and Poland between July 2017 and March 2018. An a priori thematic framework was applied and supplemented with emergent themes. Results: We report on the results of a core emergent theme - threats identified by respondents to the value of HTA in the formulary process. We classified these into internal threats that arise due to undue influence on the individuals involved in appraisal, and external threats that arise due to undue influence on the production of evidence. Discussion: Findings align with previous evidence regarding political and corporate pressures on the process, and a perception of declining quality of evidence. We contribute to the discussion by highlighting the importance of motivation of experts involved in the appraisal process. Conclusions: The recognition of internal and external threats lays the groundwork for a discussion of policies used to mitigate them. We offer suggestions about potential policy responses. (C) 2018 The Authors. Published by Elsevier B.V.