Health technology assessment (HTA) has emerged as an important tool to support healthcare decision-makers to make rational reimbursement decisions, with the ultimate purpose of promoting an efficient healthcare system. HTA agencies continue to review their methodology and refine processes and procedures to improve their practice. For pharmaceutical companies, HTA needs to be embedded from development to jurisdictional submission to HTA agencies. Interactions between HTA agencies and companies through the form of early scientific advice have been increasingly used to support evidence generation during development, in order to improve market access. Multi-stakeholder interactions between regulator, HTA agencies and companies need to be further mapped out and evaluated to assess the current experience, uptake, and value of such activities. This research is aimed to evaluate the HTA practice of pharmaceutical companies to enable better decision-making during development and at launch, examine the processes and performance of HTA agencies, and promote good practice across both stakeholders through self-improvement and interactions. The finding in this thesis has demonstrated a continuous evolution of HTA agencies throughout product lifecycles to support drug development, improve their methodology and processes, and engage in interaction with regulators and peer HTA agencies. By establishing a systematic framework to benchmark the organization and milestone performance of HTA agencies, we provided a baseline and tool to assess the evolvement of HTA. We also observed a mindset change within companies to embed HTA considerations during drug development, in order to improve the jurisdictional submission and proactively promote good HTA practice. Future opportunities for research can be built on this thesis in the context of lifecycle HTA. For example, indicators can be established to measure the interactions between agencies through development to review and assessment of new medicine. The agency benchmarking framework can be utilised as a foundation for capacity building for emerging HTA agencies, tracking and improve performance metrics and ensuring a good practice of HTA.

Wang T. Knowing me knowing you: the evolution of HTA practices and approaches from the perspectives of HTA agencies and pharmaceutical industry. Utrecht: Utrecht University; 2022.