Keywords
Abstract
Background. Health Technology Assessment (HTA) is a key policy instrument for improving the efficiency, equity, and transparency of healthcare resource allocation, particularly in low- and middle-income countries such as Iran. Despite its recognized importance, HTA development in Iran has been hindered by institutional fragmentation, limited capacity, and insufficient financial and data infrastructure. This study aimed to identify and prioritize strategic policy actions for HTA development in Iran using a Multi-Criteria Decision Analysis (MCDA) approach.
Methods. A multi-stage, mixed-methods design was employed, including a systematic literature review, 25 semi-structured expert interviews, and pilot testing. Findings from the systematic review and interviews informed the development of a comprehensive checklist of potential HTA development strategies. The checklist was validated through expert panel review and pilot-tested for reliability and usability. Eight evaluation criteria, such as feasibility, alignment with national priorities, equity, cost-effectiveness, and stakeholder acceptance, were applied within an MCDA framework to prioritize the identified strategies. Weighted scores were calculated and normalized to generate a ranked list of priorities. In addition, a structured expert consensus process was used to ensure that no essential criterion was excluded and that all selected criteria reflected both global evidence and local contextual needs.
Results. Fifteen strategies were identified and evaluated. Establishing a centralized national HTA body ranked as the top priority (weighted score: 82.25), followed by strengthening HTA workforce capacity (79.75) and securing sustainable funding (78.25). Additional high-priority strategies included promoting public awareness of HTA, integrating HTA into national policy processes, and developing robust data infrastructure. Moderate-priority strategies involved enhancing stakeholder collaboration, strengthening research and innovation, and expanding international partnerships.
Lower-priority but still important strategies included enhancing transparency, creating context-specific evaluation metrics, involving NGOs, and promoting equitable access to health technologies. Sensitivity analyses with different weighting scenarios showed consistent top-ranked strategies. This confirmed the robustness and reliability of the MCDA model.
Conclusion. The study proposes an evidence-informed roadmap for HTA development in Iran. It highlights key priorities, including a centralized authority, capacity building, and dedicated funding. These steps can support the institutionalization of HTA and its use in policy decisions. Although focused on Iran, the findings are applicable to other resource-limited settings. The MCDA approach offers a transparent method for priority-setting in HTA systems.
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