Saudamini Vishwanath Dabak

Objectives: The role of health technology assessment (HTA) is evolving. Once seen primarily as a gatekeeper, HTA is increasingly viewed as a potential shaper of health system transformation. The first plenary session of the HTA International 2025 Annual Meeting explored the potential for HTA to adopt this broader role. Methods: Drawing on perspectives from across the globe, it was discussed how HTA can help shape more equitable, responsive, and sustainable health systems by informing benefit package design, supporting universal health coverage, and addressing systemic inequities from a societal perspective. Results: Audience polling and live commentary underscored a shared sense of urgency, as well as recognition of the methodological, political, and practical constraints to this evolution. Rather than a binary choice, a continuum of roles was suggested depending on the context in which HTA is applied. Conclusions: Ultimately, HTA can shape health systems – not through ambition alone, but through evidence-informed, inclusive, and context-aware decision-making.

Health Technology Assessment (HTA) informs resource allocation and policy decisions, particularly to achieve Universal Health Coverage (UHC). Recognizing the increasing demand for evidence-informed decision-making, the HTAsiaLink network was established in 2011 as a regional platform to strengthen individual and institutional capacity in HTA research and facilitate the integration of HTA evidence into policy decisions across the Asia-Pacific. Over the years, HTAsiaLink has expanded to over fifty members from twenty economies. In 2024, a structured strategic planning process was undertaken to ensure its continued growth and strengthen its impact on HTA development and implementation. This process involved a targeted review of strategic plans from international networks, alongside comprehensive member engagement, to develop a data-driven and adaptable plan responsive to the evolving healthcare landscape and member needs. As a result, five strategic priorities, corresponding action items, and success indicators were identified. This commentary outlines the needs and processes involved in developing the network’s first-ever strategic plan, emphasizing the critical role of member engagement in shaping its future direction. We believe that this experience offers transferable insights for other HTA networks, particularly those operating in low- and middle-income country contexts, on the collaborative development of strategic plans that are responsive to shared objectives, accommodate varying institutional capacities, and align with regional priorities.

As we mark 5 years since the emergence of the COVID-19 pandemic, the world continues to face numerous epidemics of emerging and re-emerging diseases, including mpox, cholera, avian influenza, chikungunya and dengue. Concurrently, long-standing diseases such as pneumonia, tuberculosis (TB) and malaria continue to account for millions of premature and preventable deaths globally. Despite the valuable lessons in disease prevention and control during both pandemic and non-pandemic periods, gaps remain in our responses to global public health challenges, including limits to our ability to consolidate, share and analyse data to generate the evidence that policy-makers need to make the best decisions possible, at both local and global levels. Addressing these gaps requires sustained investment, development and retention of modelling and analytical capabilities, and collaboration across jurisdictions, both within and across regions, with the aim of building a united and effective global health response system. Capacity is also strengthened from sharing knowledge about the state of the art in research, and on best practices, and learning in international fora such as conferences. Efforts to enhance modelling capabilities are particularly crucial for resource-constrained countries, many of which are located in the Global South, where the gaps in data collection and analytics training are most pronounced.1

Background: Telemedicine has transformed health care delivery, offering improved access, efficiency, and potentially cost-effectiveness. However, wide-scale implementation is challenged due to multiple factors. Among these, reimbursements were reported to influence the scalability and sustainability of telemedicine. Objective: This study aimed to examine current payment models and reimbursement coverage for telemedicine in any national and subnational jurisdictions to inform the development of reimbursement policy. Methods: We conducted a scoping review using Arksey and O’Malley’s 6-stage method, including sources that discussed telemedicine payment methods reimbursed by public payers. To supplement the limited results, particularly from low- and middle-income countries in Asia, we conducted 5 stakeholder interviews with telemedicine providers or those with experience in telemedicine reimbursement models who added insights for India, Nepal, and Taiwan. Data were synthesized narratively. Results: We included 31 of 14,522 records screened. Most (n=22, 71%) records were published after 2020, were research studies (n=26, 84%), and discussed reimbursement in the United States (n=24, 77%). We categorized reimbursement coverage as the purpose of telemedicine, health conditions, patients’ nonhealth conditions, service providers, interaction participants, interaction modes, and technology used. Payment methods varied widely and included fee-for-service, capitation, bundled payment, and value-based models. Varying telemedicine reimbursement models adopted by countries reflect health service and care objectives along with health system characteristics. Payment mechanisms were linked to telemedicine services or broader health care delivery, with each presenting unique advantages. Conclusions: Workable telemedicine reimbursement is a critical enabling factor in expanding health care access by incentivizing provider participation, ensuring financial sustainability, promoting equity in access, and aligning telemedicine with broader health goals. This review provides a starting point for countries in designing a telemedicine reimbursement model specific to population needs and health system capacity. Policy makers are encouraged to leverage these insights in adapting telemedicine reimbursement to their context.

Introduction The COVID-19 pandemic highlighted the significance of mathematical modelling in decision-making and the limited capacity in many low-income and middle-income countries (LMICs). Thus, we studied how modelling supported policy decision-making processes in LMICs during the pandemic (details in a separate paper). We found that strong researcher–policymaker relationships and co-creation facilitated knowledge translation, while scepticism, political pressures and demand for quick outputs were barriers. We also noted that routine use of modelled evidence for decision-making requires sustained funding, capacity building for policy-facing modelling, robust data infrastructure and dedicated knowledge translation mechanisms. These lessons helped us co-create a framework and policy roadmap for improving the routine use of modelling evidence in public health decision-making. This communication paper describes the framework components and provides an implementation approach and evidence for the recommendations. The components include (1) funding, (2) capacity building, (3) data infrastructure, (4) knowledge translation platforms and (5) a culture of evidence use. Key arguments Our framework integrates the supply (modellers) and demand (policymakers) sides and contextual factors that enable change. It is designed to be generic and disease-agnostic for any policy decision-making that modelling could support. It is not a decision-making tool but a guiding framework to help build capacity for evidence-based policy decision-making. The target audience is modellers and policymakers, but it could include other partners and implementers in public health decision-making. Conclusion The framework was created through engagements with policymakers and researchers and reflects their real-life experiences during the COVID-19 pandemic. Its purpose is to guide stakeholders, especially in lower-resourced settings, in building modelling capacity, prioritising efforts and creating an enabling environment for using models as part of the evidence base to inform public health decision-making. To validate its robustness and impact, further work is needed to implement and evaluate this framework in diverse settings.

The Health Intervention and Technology Assessment Program (HITAP) was established in 2007. This article highlights 15 lessons from over 15 years of experience, noting five achievements about what HITAP has done well, five areas that it is currently working on, and five aims for work in the future. HITAP built capacity for HTA and linked research to policy and practice in Thailand. With collaborators from academic and policy spheres, HITAP has mobilized regional and global support, and developed global public goods to enhance the field of HTA. HITAP's semi-autonomous structure has facilitated these changes, though they have not been without their challenges. HITAP aims to continue its work on HTA for public health interventions and disinvestments, effectively engaging with stakeholders and strategically managing its human resources. Moving forward, HITAP will develop and update global public goods on HTA, work on emerging topics such as early HTA, address issues in digital health, real-world evidence and equity, support HTA development globally, particularly in low-income settings, and seek to engage more effectively with the public. HITAP seeks to learn from its experience and invest in the areas identified so that it can grow sustainably. Its journey may be relevant to other countries and institutions that are interested in developing HTA programs.

There has been an increasing demand to reimburse high-cost medicines, through public health insurance schemes in Thailand. A mixed method approach was employed. First, a rapid review of select high-income countries was conducted, followed by expert consultations and an in-depth review of three countries: Australia, England and Republic of Korea to understand reimbursement mechanisms of high-cost medicines. In Thailand, current pathways for reimbursing high-cost medicines reviewed, the potential opportunity cost estimated, and stakeholder consultations were conducted to identify context specific considerations. High-income countries reviewed have implemented a variety of pathways and mechanisms for reimbursing high-cost medicines under specific eligibility criteria, listing processes, varying cost-effectiveness thresholds and special funding arrangements. In Thailand, high-cost medicines that do not offer good value-for-money are excluded from the reimbursement process. A framework for reimbursing high-cost medicines that are not cost-effective at the current willingness-to-pay threshold was proposed for Thailand. Under this framework, specific criteria are proposed to determine their eligibility for reimbursement such life-saving nature, treatment of conditions with no alternative treatment options, and affordability. High-cost medicines may become eligible for reimbursement through alternative mechanisms based on specific criteria which depend on each context. The application of HTA methods and processes is important in guiding these decisions to support sustainable access to affordable healthcare in pursuit of Universal Health Coverage (UHC).