ABSTRACT

Objective.

To provide an overview of hospital-based health technology assessment (HB-HTA) activities in Latin America and the Caribbean, including the technologies assessed, resources utilized, evaluation methods employed, and challenges encountered.

Methods.

A scoping review focused on HB-HTA using frameworks from the Joanna Briggs Institute was conducted across databases and gray literature.

Results.

Seventeen studies were identified, and another two documents were retrieved manually at a conference, totaling 19 files. Brazil emerged as a key player in HB-HTA activities in Latin America and the Caribbean, with public teaching hospitals leading the efforts. The primary focus of HB-HTA units was assessing medicines/pharmaceuticals and medical devices, using budget impact and cost-effectiveness/utility analyses as the main appraisal tools. The review also identified challenges such as limited human resources and financial support.

Conclusions.

The study highlights a growing interest in HB-HTA in Latin America and the Caribbean, driven primarily by public institutions. The findings underscore the need for tailored approaches to strengthen evidence-based decision-making in healthcare settings and address the challenges of the region’s limited resources and financial constraints.

Keywords
Technology assessment, biomedical; decision making, organizational; Latin America; Caribbean region

RESUMEN

Objetivo.

Proporcionar una visión general de las actividades de evaluación hospitalaria de tecnologías sanitarias en América Latina y el Caribe, en la que se incluyan las tecnologías evaluadas, los recursos utilizados, los métodos de evaluación aplicados y los desafíos enfrentados.

Métodos.

realizó una revisión exploratoria sobre la evaluación hospitalaria de tecnologías sanitarias en bases de datos y en la literatura gris, para lo cual se utilizaron los marcos de referencia del Instituto Joanna Briggs.

Resultados.

encontraron 17 estudios y se obtuvieron mediante una búsqueda manual otros dos documentos de un congreso, con lo que el total fue de 19 registros. Brasil se reveló como un actor clave en las actividades de evaluación hospitalaria de tecnologías sanitarias en América Latina y el Caribe, y sus hospitales públicos universitarios son los que lideran los esfuerzos. Las unidades de evaluación hospitalaria de tecnologías sanitarias se centraron sobre todo en la evaluación de medicamentos, productos farmacéuticos y dispositivos médicos, para lo que empleaban análisis de impacto presupuestario y de costo-efectividad o costo-utilidad como principales herramientas de evaluación. La revisión también permitió detectar desafíos como la escasez de recursos humanos y económicos.

Conclusiones.

El estudio pone de manifiesto el creciente interés por la evaluación hospitalaria de tecnologías sanitarias en América Latina y el Caribe impulsado, sobre todo, por las instituciones públicas. Los resultados subrayan la necesidad de adoptar enfoques individualizados para fortalecer la toma de decisiones basadas en la evidencia en el ámbito de la salud, y afrontar los desafíos que suponen las limitaciones de recursos y las restricciones económicas en la región.

Palabras clave
Evaluación de la tecnología biomédica; toma de decisiones en la organización; América Latina; región del Caribe

RESUMEN

Objetivo.

Proporcionar um panorama da avaliação de tecnologias em saúde (ATS) em hospitais da América Latina e do Caribe, incluindo as tecnologias avaliadas, os recursos utilizados, os métodos de avaliação empregados e as dificuldades encontradas.

Métodos.

Realizou-se uma revisão de escopo sobre ATS em hospitais usando bases de dados e literatura cinzenta, com base nas estruturas de revisão do Instituto Joanna Briggs.

Resultados.

Foram identificados e analisados dezessete estudos, além de dois documentos recuperados manualmente em uma conferência, totalizando 19 arquivos. O Brasil transpareceu como um ator importante nas atividades de ATS em hospitais da América Latina e do Caribe, principalmente em hospitais universitários públicos. O foco central das unidades de ATS em hospitais era a avaliação de medicamentos e produtos farmacêuticos e dispositivos médicos, com base principalmente no impacto orçamentário e em análises de custo-efetividade/utilidade. A revisão também identificou barreiras, como a falta de recursos humanos e de apoio financeiro.

Conclusões.

Este estudo destaca que há um interesse crescente na realização de ATS em hospitais na América Latina e no Caribe, impulsionado principalmente por instituições públicas. Os resultados destacam que, na área da saúde, é necessário adotar abordagens adaptadas para aprimorar a tomada de decisões baseadas em evidências e enfrentar as limitações de recursos humanos e financeiros na região.

Palabras clave
Evaluación de la tecnología biomédica; toma de decisiones en la organización; América Latina; región del Caribe

Since the 1980s, when the healthcare field experienced a surge in new medical technologies coupled with constrained health budgets, health technology assessment (HTA) has emerged as a crucial concept (¹1. Kristensen FB, Sigmund H, editors. Health technology assessment handbook. 2nd Edition. Copenhagen: Danish Centre for Health Technology Assessment, National Board of Health; 2008.). The International Network of Agencies for Health Technology Assessment (INAHTA) and Health Technology Assessment International (HTAi) conceptualize HTA as “a multidisciplinary process that uses explicit methods to determine the value of health technology at different points in its lifecycle. The purpose is to inform decision-making in order to promote an equitable, efficient, and high-quality health system” (²2. O’Rourke B, Oortwijn W, Schuller T. The new definition of health technology assessment: A milestone in international collaboration. Int J Technol Assess Health Care. 2020;36(3):187–190. https://doi.org/10.1017/s0266462320000215.
https://doi.org/10.1017/s026646232000021... ).

HTA has gained recognition as a valuable instrument for providing decision-makers with accurate insights into the value of a particular health technology within a healthcare system. Several countries have established national HTA institutes, such as the National Institute for Health and Care Excellence (NICE) in the United Kingdom, the Haute Autorité de Santé (HAS) in France, and the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) in Sweden. These institutes generate comprehensive reports that condense a thorough evaluation of a given health technology, often spanning months, if not years (³3. Grenon X, Pinget C, Wasserfallen J-B. Hospital-based health technology assessment (HB-HTA): a 10-year survey at one unit. Int J Technol Assess Health Care. 2016;32(3):116–121. https://doi.org/10.1017/s0266462316000258.
https://doi.org/10.1017/s026646231600025... ). In 2011, the Health Technology Assessment Network of the Americas (RedETSA) was created to strengthen and promote HTA in the region (⁴4. Teerawattananon Y, Luz K, Yothasmutra C, Pwu R-F, Ahn J, Shafie AA, et al. Historical development of the HTAsiaLink network and its key determinants of success. Int J Technol Assess Health Care. 2018;34(3):260–266. https://doi.org/10.1017/s0266462318000223.
https://doi.org/10.1017/s026646231800022... ). One year later, the Pan American Health Organization (PAHO) adopted a resolution encouraging Member States to establish decision-making processes based on HTA to incorporate health technologies; to use HTA to inform public health policies, including public health system coverage decisions; to develop clinical guidelines and protocols for new technologies; and to participate actively in RedETSA (⁵5. Lessa F, Caccavo F, Curtis S, Ouimet-Rathé S, Lemgruber A. Strengthening and implementing health technology assessment and the decision-making process in the Region of the Americas. Rev Panam Salud Publica. 2017;41:e165. https://doi.org/10.26633/rpsp.2017.165.
https://doi.org/10.26633/rpsp.2017.165... ). Currently, RedETSA is composed of 42 members in 21 countries and territories: Argentina, Bermuda, Bolivia (Plurinational State of), Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Jamaica, Mexico, Panama, Paraguay, Peru, United States of America, and Uruguay (⁶6. Red de Evaluación de Tecnologías en Salud de las Américas. RedETSA: Red de Evaluación de Tecnologías en Salud de las Américas. Washington, D.C.: Pan American Health Organization; [date unknown] [cited 2023 Dec 26]. Available from: http://redetsa.org/.
http://redetsa.org/... ).

Hospital-based HTA (HB-HTA) (⁷7. Sampietro-Colom L, Morilla-Bachs I, Gutierrez-Moreno S, Gallo P. Development and test of a decision support tool for hospital health technology assessment. Int J Technol Assess Health Care. 2012;28(4):460–465. https://doi.org/10.1017/s0266462312000487.
https://doi.org/10.1017/s026646231200048... ) is a specific context within and for HTA in hospitals. This context is a multidisciplinary, systematic, and evidence-based approach that considers the clinical, economic, and organizational aspects of implementing and utilizing a particular technology in a hospital setting, considering moving the assessment closer to the point of care, where technologies’ costs, impacts, and benefits can be directly assessed (⁸8. Gagnon MP, Desmartis M, Poder T, Witteman W. Effects and repercussions of local/hospital-based health technology assessment (HTA): a systematic review. Syst Rev. 2014;3:129. https://doi.org/10.1186/2046-4053-3-129.
https://doi.org/10.1186/2046-4053-3-129... , ⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care. 2015;31(1–2):103–110. https://doi.org/10.1017/s0266462315000124.
https://doi.org/10.1017/s026646231500012... ). The foundational knowledge supporting HB-HTA aligns with that employed in national/regional HTA. Nevertheless, the tools and data necessary for making informed decisions regarding implementing a specific new health technology, timing, and the weighting assigned to various assessment criteria may vary across contexts. Local decision-makers require flexibility and tailored solutions to adopt a particular technology. Traditional HTA reports are often time-intensive, and the scope of assessment at the local level can differ significantly from that at the national level (⁷7. Sampietro-Colom L, Morilla-Bachs I, Gutierrez-Moreno S, Gallo P. Development and test of a decision support tool for hospital health technology assessment. Int J Technol Assess Health Care. 2012;28(4):460–465. https://doi.org/10.1017/s0266462312000487.
https://doi.org/10.1017/s026646231200048... ).

HB-HTA encompasses the gathering and examination of scientific evidence concerning the clinical efficacy of the technology, its influence on patient outcomes, and its economic and organizational viability. Additionally, it considers the required training, resources, and effects on healthcare personnel (⁷7. Sampietro-Colom L, Morilla-Bachs I, Gutierrez-Moreno S, Gallo P. Development and test of a decision support tool for hospital health technology assessment. Int J Technol Assess Health Care. 2012;28(4):460–465. https://doi.org/10.1017/s0266462312000487.
https://doi.org/10.1017/s026646231200048... ). HB-HTA aims to provide solid and relevant information to support evidence-based decision-making regarding adopting and using health technologies in hospitals. This information helps healthcare managers decide which technologies are most suitable for their institutions, considering clinical benefits, barriers, efficiency, available resources, and patient needs (⁷7. Sampietro-Colom L, Morilla-Bachs I, Gutierrez-Moreno S, Gallo P. Development and test of a decision support tool for hospital health technology assessment. Int J Technol Assess Health Care. 2012;28(4):460–465. https://doi.org/10.1017/s0266462312000487.
https://doi.org/10.1017/s026646231200048... ). Existing evidence suggests that HB-HTA programs yield positive outcomes in healthcare institutions, enhancing the quality of care and generating substantial financial savings (⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care. 2015;31(1–2):103–110. https://doi.org/10.1017/s0266462315000124.
https://doi.org/10.1017/s026646231500012... ).

Spain was the first country to implement an HB-HTA tool (Andalusian HTA Agency) in 1999. The Danish Centre for Evaluation and Health Technology Assessment (DACEHTA) developed the concept of mini-HTA in 2005 (⁷7. Sampietro-Colom L, Morilla-Bachs I, Gutierrez-Moreno S, Gallo P. Development and test of a decision support tool for hospital health technology assessment. Int J Technol Assess Health Care. 2012;28(4):460–465. https://doi.org/10.1017/s0266462312000487.
https://doi.org/10.1017/s026646231200048... ). During the early 2000s, several HB-HTA initiatives were documented in the literature, primarily in Canada and the United States of America (⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care. 2015;31(1–2):103–110. https://doi.org/10.1017/s0266462315000124.
https://doi.org/10.1017/s026646231500012... ). In Latin America, an HB-HTA program was implemented in 2001 at a public national pediatric teaching facility with a self-managed budget in Argentina (¹⁰10. Rosselli D, Quirland-Lazo C, Csanádi M, Ruiz de Castilla EM, González NC, Valdés J, et al. HTA Implementation in Latin American Countries: Comparison of Current and Preferred Status. Value Health Reg Issues. 2017;14:20–27. https://doi.org/10.1016/j.vhri.2017.02.004.
https://doi.org/10.1016/j.vhri.2017.02.0... , ¹¹11. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-Based HTA in Argentina: The Hospital Garrahan and Hospital El Cruce Experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-Based Health Technology Assessment. Cham: Springer International Publishing; 2016:247–261. https://doi.org/10.1007/978-3-319-39205-9_21.
https://doi.org/10.1007/978-3-319-39205-... ).

Formally, the Ministry of Health (MoH) of Argentina established the national coordinating HTA unit in 2009, which joined other state HTA initiatives to become the Argentinian HTA network (Red Argentina Pública de Evaluación de Tecnologías Sanitarias – RedARETS) in 2012 (¹¹11. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-Based HTA in Argentina: The Hospital Garrahan and Hospital El Cruce Experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-Based Health Technology Assessment. Cham: Springer International Publishing; 2016:247–261. https://doi.org/10.1007/978-3-319-39205-9_21.
https://doi.org/10.1007/978-3-319-39205-... ).

In 2008, the MoH of Brazil established the Brazilian HTA Network (REBRATS), which linked 15 HTA units distributed throughout universities, medical schools, and teaching hospitals (¹²12. Santos M, Magliano C, Kelles DB, Kelles SMB, Stein A. The Role of Hospitals in HTA in Brazil. In: Sampietro-Colom L, Martin J, editors. Hospital-Based Health Technology Assessment. Cham: Springer International Publishing; 2016:239–246. https://doi.org/10.1007/978-3-319-39205-9_20.
https://doi.org/10.1007/978-3-319-39205-... ). Since 2009, the MoH of Brazil has established 24 hospital-based HTA units (NATS) (¹³13. de Soárez PC, Pepe VLE, Novaes HMD. Hospital-based health technology assessment in Brazil: current experiences and challenges. Int J Technol Assess Health Care. 2021;37(1):e86. https://doi.org/10.1017/S0266462321000581.
https://doi.org/10.1017/S026646232100058... ). The NATS, currently present in about 113 hospitals, approximate academic institutions and the HTA unit to support the decision-making processes of new technologies in the national health system (SUS) (¹⁴14. Novaes HMD, Soárez PC De. A Avaliação das Tecnologias em Saúde: origem, desenvolvimento e desafios atuais. Panorama internacional e Brasil. Cad Saude Publica. 2020;36(9):e00006820. https://doi.org/10.1590/0102-311x00006820.
https://doi.org/10.1590/0102-311x0000682... ). Since then, the MoH of Brazil has been working on strategies to expand this network (¹⁵15. Guimarães R, Morel CM, Aragão É, Paranhos J, Palácios M, Goldbaum M, et al. Política de Ciência, Tecnologia e Inovação em Saúde (CT&I/S): uma atualização para debate. Cien Saude Colet. 2021;26(12):6105–6116. https://doi.org/10.1590/1413-812320212612.18632021.
https://doi.org/10.1590/1413-81232021261... ). However, in the hospital context, the institutionalization of HTA is still in process in Brazil (¹²12. Santos M, Magliano C, Kelles DB, Kelles SMB, Stein A. The Role of Hospitals in HTA in Brazil. In: Sampietro-Colom L, Martin J, editors. Hospital-Based Health Technology Assessment. Cham: Springer International Publishing; 2016:239–246. https://doi.org/10.1007/978-3-319-39205-9_20.
https://doi.org/10.1007/978-3-319-39205-... , ¹⁴14. Novaes HMD, Soárez PC De. A Avaliação das Tecnologias em Saúde: origem, desenvolvimento e desafios atuais. Panorama internacional e Brasil. Cad Saude Publica. 2020;36(9):e00006820. https://doi.org/10.1590/0102-311x00006820.
https://doi.org/10.1590/0102-311x0000682... , ¹⁶16. Departamento de Ciência e Tecnologia, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Ministério da Saúde. Consolidação da área de avaliação de tecnologias em saúde no Brasil. Rev Saude Publica. 2010;44(2):381–383. https://doi.org/10.1590/S0034-89102010000200022.
https://doi.org/10.1590/S0034-8910201000... ).

Networking has facilitated cooperation across centers and direct involvement in global and regional networks such as INAHTA and RedETSA (¹¹11. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-Based HTA in Argentina: The Hospital Garrahan and Hospital El Cruce Experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-Based Health Technology Assessment. Cham: Springer International Publishing; 2016:247–261. https://doi.org/10.1007/978-3-319-39205-9_21.
https://doi.org/10.1007/978-3-319-39205-... ).

In countries where the HB-HTA role is still being defined and developed, a better understanding of the hospital’s capability may help delineate how the HB-HTA role fits within existing hospital care structures. A scoping review is useful to map the extent and type of available evidence without assessing its quality. In the context of HB-HTA in Latin America and the Caribbean (LAC), this approach helps identify knowledge gaps and uneven access to data on emerging technologies. It provides a foundation for future research or systematic reviews that may later support policy or guideline development. Thus, this review focused on exploring existing literature on HB-HTA in LAC, aiming to provide an overview of the technologies assessed, resources utilized, evaluation methods employed, and challenges encountered by HB-HTA units in LAC.

MATERIALS AND METHODS

Scoping review protocol

An a priori protocol was developed and registered with the Open Science Framework (https://osf.io/gzdvq) following established scoping review frameworks from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis (¹⁷17. Aromataris E, Munn Z. JBI Manual for Evidence Synthesis. [Adelaide]: JBI; 2020. https://doi.org/10.46658/JBIMES-24-01.
https://doi.org/10.46658/JBIMES-24-01... ). The reporting of this study conforms to the PRISMA statement for scoping review standards, PRISMA-ScR (¹⁸18. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467–473. https://doi.org/10.7326/m18-0850.
https://doi.org/10.7326/m18-0850... ).

Purpose and statement of the scoping review

This scoping review aimed to map the use of HB-HTA in the published literature in the LAC region. As secondary objectives, it aimed to identify the technologies appraised, the financial and human resources involved, the methods usually applied for technology appraisal, and the barriers reported by HB-HTA units in the LAC region.

Systematic search strategy

Identification. The primary electronic bibliographic databases used for evidence searching were MEDLINE (Ovid), LILACS, Embase, and Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA). Other sources used for gray literature from 2019 to 2023 were health or HTA organizations in the LAC region, CAPES Dissertations and Theses for Brazil, and Google Scholar (with advanced search strategies) for Argentina, Brazil, Colombia, and Peru. The initial search was conducted on 25 May 2023, with another on 11 September 2023 to identify additional publications. Literature was also identified from the references of the retrieved articles using citation tracking.

Eligibility criteria. This scoping review considered all types of studies containing descriptions or methods relating to HB-HTA in the LAC region. These criteria were applied manually and using the automatic sorting function in the databases. The research question was based on the PCC elements (population, concept, and context) considering the following inclusion criteria:

Population. This scoping review considered studies addressing HB-HTA.

Concept. The concept of interest was HB-HTA as a combination approach of clinical, economic, and organizational aspects of implementing and utilizing a particular technology in a hospital setting.

Context. This scoping review considered studies conducted in hospital settings in the LAC region.

Types of sources. This scoping review considered studies addressing HB-HTA with no restriction on the type of study. A search of the gray literature included, but was not limited to, expert opinions, clinical guidelines, technical guides, dissertations and theses, editorials, articles, and reports on policies and strategies in use by organizations.

Screening and eligibility

The titles and abstracts of the articles were checked to ensure that the studies matched the predetermined inclusion criteria by peers. Disagreements were resolved by discussion and consensus.

Data extraction, synthesis, and analysis

Data were extracted using a predesigned data extraction table and synthesized narratively to identify similarities and differences across the approaches.

Search on HTA agency websites

We hand-searched the websites of HTA agencies in LAC for published documents or other material that supports the development of the HTA process for organizing and performing HB-HTA. A list of agencies was obtained by investigating RedETSA members. The list of the searched agencies can be made available on request. The search was conducted in the same period as the literature search. The search comprised the terms: “hospital-based health technology assessment,” “hospital based health technology assessment,” “HB-HTA,” and “HB HTA”; “evaluación de tecnologías sanitarias en hospitales,” “ETS hospitalaria,” “evaluación de tecnologías en salud de base hospitalaria,” and “ETS-BH.”

RESULTS

Structured searches in electronic databases retrieved 2 939 references, and unstructured searches in additional sources resulted in 505 references. Additionally, 8 records were identified by manual search, totaling 3 452 references. After removing 286 duplicates, 3 166 references were analyzed through titles and abstracts, and 3 091 were eliminated for not meeting the eligibility criteria. Thus, in the second stage of the selection process, the full texts of 75 references were analyzed. Of these, 58 were excluded. The list of excluded references and the reasons for exclusion can be made available to the interested reader on request. At the end of the selection process, this review included 17 studies (Figure 1). The hand search on the RedETSA members’ websites found 34 agencies in Latin America and 4 in the Caribbean. The search retrieved no documents regarding HB-HTA in the LAC region. Despite this, two recently published documents were personally obtained by one of the authors and were included in the review, totaling 19 documents.

Characteristics of the studies included

Table 1 depicts the main characteristics of the studies included in this review. There was a clear tendency of increase in the number of studies involving HB-HTA in the LAC region (16% published before 2015 and 84% between 2015 and 2023). The studies were produced mainly in Brazil (68%), followed by Argentina (11%), Colombia (11%) and Peru (5%). Despite being outside the LAC region, Canada also contributed to knowledge production about HB-HTA in Latin America, with one published study. Most studies were descriptive (32%), followed by conference proceedings, thesis, and literature review (16% each). One experience report, short communication, guide, and survey were also found (5% each).

Figure 2 shows the functional characteristics of HB-HTA institutions in LAC. The main context found was the Brazilian HB-HTA (67%), followed by Argentina (19%). There was one study referring to HB-HTA in Peru (5%). Two institutional documents regarding HB-HTA in Colombia (10%) were found. In the LAC context, HB-HTA is mainly active in public teaching hospitals (83%). Private/philanthropic hospitals engaged in HB-HTA processes were found in this review to a lesser extent (6%). As expected, most hospitals identified were involved in local HTA processes (71%). However, 18% of the studies reported that some institutions took part in national-level HTA processes in addition to the local level.

Although 45% of the studies did not report their financial sources, 20% declared that the HB-HTA was supported by public funding, and 15% were maintained exclusively by the institution’s resources. A few institutions received some kind of external financing (10%) or research grants (10%). The human resources engaged in HB-HTA mainly comprised part-time staff (18%), and only a few studies reported a full-time dedicated HTA team (6%). However, most studies included in this review (76%) did not report any information about staff.

The leading technologies appraised by those institutions were medicines/pharmaceuticals (40%) and medical devices (37%), followed by laboratory tests or diagnostic kits (10%), protocols or procedures (7%), and emerging technologies (3%). Economic evaluations were the primary appraisal tool reported in the studies (48%). Twenty percent of the total economic evaluations comprised budget impact analysis, 20% comprised cost-effectiveness/utility analysis, and cost analysis represented 7%. In contrast, 53% did not specify the type of economic evaluation. Next, mini-HTA/technical-scientific reports and synthesis methods (13% each), efficacy/effectiveness (10% each), and safety and multicriteria decision analysis (3% each) were also identified as appraisal tools utilized by HB-HTA institutions in LAC.

Finally, the main barriers to HB-HTA in LAC identified in this review were educational/specialized training (28%), lack of dedicated human resources (18%), and financial support (15%). Interestingly, minor problems (less than 10% each) were identified, such as inadequate physical structure, insufficient material and resources, lack of structured process, internal communication, acceptance of the HTA results, and political issues. Table 2 shows the summary of evidence by study.

DISCUSSION

This scoping review was conducted to map the application of HB-HTA in LAC, identifying how widespread this concept is in the region, the kind of institutions involved in the HB-HTA process, their sources of economic support, human resources, what type of technology those institutions usually evaluate, their appraisal tools, and what kind of challenges they face.

This review identified 17 studies and two institutional documents regarding HB-HTA in LAC. Most papers in the present review originated from the Brazilian context, followed by the Argentinean context, countries where established HB-HTA activity was identified previously (¹⁹19. Galdino JPDS, Camargo EB, Elias FTS. Sedimentação da avaliação de tecnologias em saúde em hospitais: uma revisão de escopo. Cad Saude Publica. 2021;37(9):e00352520. https://doi.org/10.1590/0102-311x00352520.
https://doi.org/10.1590/0102-311x0035252... ). No study related to Caribbean countries was found, which suggests that this region has both need and potential to develop HTA locally. Although no documents were found on the websites of LAC institutions members of RedETSA, during a conference, an HTA guide from Colombia that mentioned HB-HTA (²⁰20. Instituto de Evaluación Tecnológica en Salud. Manual de evaluación para la incorporación de tecnologías sanitarias en instituciones prestadoras de servicios de salud. Bogotá: IETS; 2022.) and a survey on HTA in Colombia (²¹21. Valencia JCG, Grupo de Investigación y proyectos ACHC. Una mirada a la evaluación de tecnología hospitalaria. Hospitalaria. 2022;23(138):4–26. Available from: https://revistahospitalaria.org/enportada/una-mirada-a-la-evaluacion-de-tecnologia-hospitalaria/.
https://revistahospitalaria.org/enportad... ) were noticed and could be retrieved. It was found that 26%, 33%, and 7% of high, medium, and low complexity institutions affiliated with the Colombian Association of Hospitals and Clinics (ACHC) have a technology evaluation area within their organization (²¹21. Valencia JCG, Grupo de Investigación y proyectos ACHC. Una mirada a la evaluación de tecnología hospitalaria. Hospitalaria. 2022;23(138):4–26. Available from: https://revistahospitalaria.org/enportada/una-mirada-a-la-evaluacion-de-tecnologia-hospitalaria/.
https://revistahospitalaria.org/enportad... ). To the authors’ knowledge, the AdHopHTA handbook (²²22. Sampietro-Colom L, Lach K, Pasternack I, Wasserfallen J-B, Cicchetti A, Marchetti M, et al. Guiding principles for good practices in hospital-based health technology assessment units. Int J Technol Assess Health Care. 2015;31(6):457–465. https://doi.org/10.1017/s0266462315000732.
https://doi.org/10.1017/s026646231500073... ) remains the reference document supporting organizing and conducting HTA at the hospital level.

Despite the imbalanced distribution of studies per country in Latin America, the HB-HTA is predominantly developed by public hospitals (¹³13. de Soárez PC, Pepe VLE, Novaes HMD. Hospital-based health technology assessment in Brazil: current experiences and challenges. Int J Technol Assess Health Care. 2021;37(1):e86. https://doi.org/10.1017/S0266462321000581.
https://doi.org/10.1017/S026646232100058... , ¹⁹19. Galdino JPDS, Camargo EB, Elias FTS. Sedimentação da avaliação de tecnologias em saúde em hospitais: uma revisão de escopo. Cad Saude Publica. 2021;37(9):e00352520. https://doi.org/10.1590/0102-311x00352520.
https://doi.org/10.1590/0102-311x0035252... , ²³23. Morais QCD, Santos MS. Multi-Criteria Model for Evaluating Drugs to Prevent Deep Venous Thrombosis Associated With Orthopedic Surgery: A Hospital-Based Case Study. Value Health Reg Issues. 2020;23:105–111. https://doi.org/10.1016/j.vhri.2020.08.002.
https://doi.org/10.1016/j.vhri.2020.08.0... –³⁶36. Demirdjian G. OP164 Hospital budget impact of high-cost drugs: the case of Nusinersen. Int J Technol Assess Health Care. 2018;34(S1):60–60. https://doi.org/10.1017/s0266462318001691.
https://doi.org/10.1017/s026646231800169... ), generally teaching hospitals (¹⁹19. Galdino JPDS, Camargo EB, Elias FTS. Sedimentação da avaliação de tecnologias em saúde em hospitais: uma revisão de escopo. Cad Saude Publica. 2021;37(9):e00352520. https://doi.org/10.1590/0102-311x00352520.
https://doi.org/10.1590/0102-311x0035252... , ²⁵25. Silva Rodrigues AK, De Oliveira Júnior LB, Pereira dos Santos LF, Dos Santos Jaernevay ML. Diagnóstico situacional de um hospital universitário de Minas Gerais a partir dos resultados do processo de avaliação interna da qualidade. HU Rev. 2022;48:1–11. https://doi.org/10.34019/1982-8047.2022.v48.34666.
https://doi.org/10.34019/1982-8047.2022.... , ²⁶26. Pereira CC de A, Rabello R dos S, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care. 2017;33(2):227–231. https://doi.org/10.1017/s0266462317000459.
https://doi.org/10.1017/s026646231700045... , ²⁹29. Cohen M, Lima AF, Miguel S, Aziz M, Cardoso RB, Cruz L. PP99 Hospital-based health technology assessment units in Brazil: present and future. Int J Technol Assess Health Care. 2019;35(S1):56–57. https://doi.org/10.1017/S0266462319002344.
https://doi.org/10.1017/S026646231900234... , ³³33. Trindade EM. Incorporação e avaliação de novas tecnologias no sistema de serviços de saúde brasileiro: estudo de caso na área de cardiologia [Thesis]. São Paulo: Universidade de São Paulo; 2006. https://doi.org/10.11606/T.5.2006.tde-22112006-131244.
https://doi.org/10.11606/T.5.2006.tde-22... ). In the Brazilian context, for instance, HTA was implemented with governmental support (¹¹11. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-Based HTA in Argentina: The Hospital Garrahan and Hospital El Cruce Experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-Based Health Technology Assessment. Cham: Springer International Publishing; 2016:247–261. https://doi.org/10.1007/978-3-319-39205-9_21.
https://doi.org/10.1007/978-3-319-39205-... , ¹²12. Santos M, Magliano C, Kelles DB, Kelles SMB, Stein A. The Role of Hospitals in HTA in Brazil. In: Sampietro-Colom L, Martin J, editors. Hospital-Based Health Technology Assessment. Cham: Springer International Publishing; 2016:239–246. https://doi.org/10.1007/978-3-319-39205-9_20.
https://doi.org/10.1007/978-3-319-39205-... ) to assist decision-making processes regarding new technologies to be incorporated into the national health system (¹⁴14. Novaes HMD, Soárez PC De. A Avaliação das Tecnologias em Saúde: origem, desenvolvimento e desafios atuais. Panorama internacional e Brasil. Cad Saude Publica. 2020;36(9):e00006820. https://doi.org/10.1590/0102-311x00006820.
https://doi.org/10.1590/0102-311x0000682... ). Our review identified only three studies (18%) in the Brazilian context, reporting intervention at a national level. However, a significant number of hospitals underlie these few studies. For instance, one study with 23 of the 24 HTA centers (NATS) affiliated with the Brazilian HTA network at that time showed that 35% of the HTA centers reported receiving internal demands (from hospital management, pharmacy, or therapeutic commissions) concerning technology acquisition. On the other hand, 26% of the HTA centers reported receiving requests from the national level via MoH (²⁶26. Pereira CC de A, Rabello R dos S, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care. 2017;33(2):227–231. https://doi.org/10.1017/s0266462317000459.
https://doi.org/10.1017/s026646231700045... ). Three studies reported this intervention of state and federal public hospital participants of the Brazilian HTA network on local and national HTA processes (¹³13. de Soárez PC, Pepe VLE, Novaes HMD. Hospital-based health technology assessment in Brazil: current experiences and challenges. Int J Technol Assess Health Care. 2021;37(1):e86. https://doi.org/10.1017/S0266462321000581.
https://doi.org/10.1017/S026646232100058... , ²⁶26. Pereira CC de A, Rabello R dos S, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care. 2017;33(2):227–231. https://doi.org/10.1017/s0266462317000459.
https://doi.org/10.1017/s026646231700045... , ³⁵35. Francisco F de R. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais [Dissertation]. São Paulo: Escola de Administração de Empresas de São Paulo; 2017. Available from: https://hdl.handle.net/10438/18165.
https://hdl.handle.net/10438/18165... ).

Studies that reported their sources of financing pointed to public funding as the primary source of financial support for HB-HTA units (¹⁹19. Galdino JPDS, Camargo EB, Elias FTS. Sedimentação da avaliação de tecnologias em saúde em hospitais: uma revisão de escopo. Cad Saude Publica. 2021;37(9):e00352520. https://doi.org/10.1590/0102-311x00352520.
https://doi.org/10.1590/0102-311x0035252... , ²⁴24. Oliveira FAM de. Incorporação de equipamentos médicos hospitalares no Sistema Único de Saúde (SUS): Um Estudo de Caso da aquisição de Equipamento de Diagnóstico por Imagem [Dissertation]. Rio de Janeiro: Instituto Nacional de Cardiologia; 2021. Available from: https://dspace.inc.saude.gov.br/items/c6a1e93b-b7de-4e58-822b-7d9807bcba99/full.
https://dspace.inc.saude.gov.br/items/c6... , ³³33. Trindade EM. Incorporação e avaliação de novas tecnologias no sistema de serviços de saúde brasileiro: estudo de caso na área de cardiologia [Thesis]. São Paulo: Universidade de São Paulo; 2006. https://doi.org/10.11606/T.5.2006.tde-22112006-131244.
https://doi.org/10.11606/T.5.2006.tde-22... , ³⁵35. Francisco F de R. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais [Dissertation]. São Paulo: Escola de Administração de Empresas de São Paulo; 2017. Available from: https://hdl.handle.net/10438/18165.
https://hdl.handle.net/10438/18165... ). Still, some centers are maintained by the institution’s resources (¹³13. de Soárez PC, Pepe VLE, Novaes HMD. Hospital-based health technology assessment in Brazil: current experiences and challenges. Int J Technol Assess Health Care. 2021;37(1):e86. https://doi.org/10.1017/S0266462321000581.
https://doi.org/10.1017/S026646232100058... , ²⁶26. Pereira CC de A, Rabello R dos S, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care. 2017;33(2):227–231. https://doi.org/10.1017/s0266462317000459.
https://doi.org/10.1017/s026646231700045... –²⁸28. Lima RA, Brazorotto JS. Análise situacional da incorporação de tecnologias em hospitais públicos federais no Brasil. Enferm Foco. 2023;14:e-202343. https://doi.org/10.21675/2357-707X.2023.v14.e-202343.
https://doi.org/10.21675/2357-707X.2023.... ), and other sources of financial support were reported, such as external financing (¹³13. de Soárez PC, Pepe VLE, Novaes HMD. Hospital-based health technology assessment in Brazil: current experiences and challenges. Int J Technol Assess Health Care. 2021;37(1):e86. https://doi.org/10.1017/S0266462321000581.
https://doi.org/10.1017/S026646232100058... , ²⁶26. Pereira CC de A, Rabello R dos S, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care. 2017;33(2):227–231. https://doi.org/10.1017/s0266462317000459.
https://doi.org/10.1017/s026646231700045... ) and grants (²⁶26. Pereira CC de A, Rabello R dos S, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care. 2017;33(2):227–231. https://doi.org/10.1017/s0266462317000459.
https://doi.org/10.1017/s026646231700045... , ³³33. Trindade EM. Incorporação e avaliação de novas tecnologias no sistema de serviços de saúde brasileiro: estudo de caso na área de cardiologia [Thesis]. São Paulo: Universidade de São Paulo; 2006. https://doi.org/10.11606/T.5.2006.tde-22112006-131244.
https://doi.org/10.11606/T.5.2006.tde-22... , ³⁵35. Francisco F de R. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais [Dissertation]. São Paulo: Escola de Administração de Empresas de São Paulo; 2017. Available from: https://hdl.handle.net/10438/18165.
https://hdl.handle.net/10438/18165... ). Records show that 56% of the Brazilian HTA centers received grants for their establishment (²⁶26. Pereira CC de A, Rabello R dos S, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care. 2017;33(2):227–231. https://doi.org/10.1017/s0266462317000459.
https://doi.org/10.1017/s026646231700045... ). However, after establishment, some institutions continue to receive grants supporting the development of their HTA activities (³³33. Trindade EM. Incorporação e avaliação de novas tecnologias no sistema de serviços de saúde brasileiro: estudo de caso na área de cardiologia [Thesis]. São Paulo: Universidade de São Paulo; 2006. https://doi.org/10.11606/T.5.2006.tde-22112006-131244.
https://doi.org/10.11606/T.5.2006.tde-22... , ³⁵35. Francisco F de R. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais [Dissertation]. São Paulo: Escola de Administração de Empresas de São Paulo; 2017. Available from: https://hdl.handle.net/10438/18165.
https://hdl.handle.net/10438/18165... ).

In another context, Argentina’s healthcare system is divided into three main sectors: public, social security, and private. The public sector provides free access and follows a decentralized scheme, with financing and healthcare delivery managed at provincial or municipal levels while receiving general policy guidance from the Argentinian MoH (¹¹11. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-Based HTA in Argentina: The Hospital Garrahan and Hospital El Cruce Experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-Based Health Technology Assessment. Cham: Springer International Publishing; 2016:247–261. https://doi.org/10.1007/978-3-319-39205-9_21.
https://doi.org/10.1007/978-3-319-39205-... ). The Argentinian healthcare system is fragmented, with considerable overlap between sectors and jurisdictions (¹¹11. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-Based HTA in Argentina: The Hospital Garrahan and Hospital El Cruce Experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-Based Health Technology Assessment. Cham: Springer International Publishing; 2016:247–261. https://doi.org/10.1007/978-3-319-39205-9_21.
https://doi.org/10.1007/978-3-319-39205-... ). Hospitals receive funding from different levels of government and the healthcare sector, including national, regional, state, and municipal sources, as well as private and social security sectors. For example, hospitals such as Garrahan and El Cruce are national hospitals that receive partial funding from the national MoH, with the remaining budget allocated by the city or province of Buenos Aires, respectively (¹¹11. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-Based HTA in Argentina: The Hospital Garrahan and Hospital El Cruce Experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-Based Health Technology Assessment. Cham: Springer International Publishing; 2016:247–261. https://doi.org/10.1007/978-3-319-39205-9_21.
https://doi.org/10.1007/978-3-319-39205-... ).

The primary focus of HB-HTA is technology appraisal, and most institutions have a well-defined prioritization process (²⁹29. Cohen M, Lima AF, Miguel S, Aziz M, Cardoso RB, Cruz L. PP99 Hospital-based health technology assessment units in Brazil: present and future. Int J Technol Assess Health Care. 2019;35(S1):56–57. https://doi.org/10.1017/S0266462319002344.
https://doi.org/10.1017/S026646231900234... ). Medicines (40%) and medical devices (37%) are the most frequently appraised technology reported in LAC. Yet, tests and diagnostic kits (³⁷37. Hasdeu S, Lamfre L, Lovera S. Evaluación de la incorporación de un sistema automatizado de cultivo microbiológico en un hospital público de Neuquén. Rev Argent Salud Publica. 2015;6(23):35–38. Available from: https://rasp.msal.gov.ar/index.php/rasp/article/view/225.
https://rasp.msal.gov.ar/index.php/rasp/... ), protocols and procedures, and novel technologies are also assessed locally (²⁹29. Cohen M, Lima AF, Miguel S, Aziz M, Cardoso RB, Cruz L. PP99 Hospital-based health technology assessment units in Brazil: present and future. Int J Technol Assess Health Care. 2019;35(S1):56–57. https://doi.org/10.1017/S0266462319002344.
https://doi.org/10.1017/S026646231900234... ).

The main appraisal tools used by HB-HTA institutions in LAC are based on economic evaluation, synthesis methods and mini-HTA, and efficacy/effectiveness studies. Almost half (48%) of the appraisal tools reported were economic evaluations. Most of those studies reporting economic evaluations did not specify the kind of economic analysis (53%). However, when reported, budget impact (20%) and cost-effectiveness/cost-utility (20%) were the main appraisal tools used. Previous reports in the Brazilian context (²⁹29. Cohen M, Lima AF, Miguel S, Aziz M, Cardoso RB, Cruz L. PP99 Hospital-based health technology assessment units in Brazil: present and future. Int J Technol Assess Health Care. 2019;35(S1):56–57. https://doi.org/10.1017/S0266462319002344.
https://doi.org/10.1017/S026646231900234... ) reflect the predominance of budget impact and cost-effectiveness analysis as dimensions of HTA observed in the present review. However, the heterogeneity of sedimentation of HB-HTA in the same context is a reality and worth considering. For example, there are institutions where no economic evaluation is carried out. In this case, synthesis methods, mini-HTA, technical–scientific opinion, and evidence-based assessment were found to be the main appraisal tools used (³⁵35. Francisco F de R. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais [Dissertation]. São Paulo: Escola de Administração de Empresas de São Paulo; 2017. Available from: https://hdl.handle.net/10438/18165.
https://hdl.handle.net/10438/18165... ). One possible explanation for the unbalanced development is a lack of dedicated and professionally trained staff at several HB-HTA centers. Indeed, the most frequent barriers reported in the included studies were education and a lack of dedicated human resources (¹³13. de Soárez PC, Pepe VLE, Novaes HMD. Hospital-based health technology assessment in Brazil: current experiences and challenges. Int J Technol Assess Health Care. 2021;37(1):e86. https://doi.org/10.1017/S0266462321000581.
https://doi.org/10.1017/S026646232100058... , ¹⁹19. Galdino JPDS, Camargo EB, Elias FTS. Sedimentação da avaliação de tecnologias em saúde em hospitais: uma revisão de escopo. Cad Saude Publica. 2021;37(9):e00352520. https://doi.org/10.1590/0102-311x00352520.
https://doi.org/10.1590/0102-311x0035252... , ²³23. Morais QCD, Santos MS. Multi-Criteria Model for Evaluating Drugs to Prevent Deep Venous Thrombosis Associated With Orthopedic Surgery: A Hospital-Based Case Study. Value Health Reg Issues. 2020;23:105–111. https://doi.org/10.1016/j.vhri.2020.08.002.
https://doi.org/10.1016/j.vhri.2020.08.0... , ²⁶26. Pereira CC de A, Rabello R dos S, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care. 2017;33(2):227–231. https://doi.org/10.1017/s0266462317000459.
https://doi.org/10.1017/s026646231700045... –³⁰30. Taype-Rondan A, Soriano-Moreno DR, Quincho-Lopez A, Martinez-Rivera RN, Mejia JR, Timaná-Ruiz R. Características metodológicas de las evaluaciones de tecnologías sanitarias elaboradas en Perú, 2019-2021. Rev Cuerpo Med HNAAA. 2022;15(Supl. 1). Available from: https://cmhnaaa.org.pe/ojs/index.php/rcmhnaaa/article/view/1435.
https://cmhnaaa.org.pe/ojs/index.php/rcm... , ³³33. Trindade EM. Incorporação e avaliação de novas tecnologias no sistema de serviços de saúde brasileiro: estudo de caso na área de cardiologia [Thesis]. São Paulo: Universidade de São Paulo; 2006. https://doi.org/10.11606/T.5.2006.tde-22112006-131244.
https://doi.org/10.11606/T.5.2006.tde-22... , ³⁵35. Francisco F de R. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais [Dissertation]. São Paulo: Escola de Administração de Empresas de São Paulo; 2017. Available from: https://hdl.handle.net/10438/18165.
https://hdl.handle.net/10438/18165... , ³⁸38. Attieh R, Gagnon M-P. Implementation of local/hospital-based health technology assessment initiatives in low- and middle-income countries. Int J Technol Assess Health Care. 2012;28(4):445–451. https://doi.org/10.1017/s026646231200058x.
https://doi.org/10.1017/s026646231200058... ). Typically, HB-HTA workers are part-time (¹³13. de Soárez PC, Pepe VLE, Novaes HMD. Hospital-based health technology assessment in Brazil: current experiences and challenges. Int J Technol Assess Health Care. 2021;37(1):e86. https://doi.org/10.1017/S0266462321000581.
https://doi.org/10.1017/S026646232100058... , ²⁸28. Lima RA, Brazorotto JS. Análise situacional da incorporação de tecnologias em hospitais públicos federais no Brasil. Enferm Foco. 2023;14:e-202343. https://doi.org/10.21675/2357-707X.2023.v14.e-202343.
https://doi.org/10.21675/2357-707X.2023.... , ³⁵35. Francisco F de R. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais [Dissertation]. São Paulo: Escola de Administração de Empresas de São Paulo; 2017. Available from: https://hdl.handle.net/10438/18165.
https://hdl.handle.net/10438/18165... ), and few centers have more than 10 professionals engaged in HTA activities (²⁶26. Pereira CC de A, Rabello R dos S, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care. 2017;33(2):227–231. https://doi.org/10.1017/s0266462317000459.
https://doi.org/10.1017/s026646231700045... ). For this reason, beyond technology appraisal, many institutions are also involved in educational or training activities (²⁹29. Cohen M, Lima AF, Miguel S, Aziz M, Cardoso RB, Cruz L. PP99 Hospital-based health technology assessment units in Brazil: present and future. Int J Technol Assess Health Care. 2019;35(S1):56–57. https://doi.org/10.1017/S0266462319002344.
https://doi.org/10.1017/S026646231900234... ). For instance, the Colombian Institute of Health Technology Assessment (IETS) produced a guide for incorporating health technologies into institutions providing health services, adapting the AdHopHTA checklist for a high-quality HB-HTA report for use in its context (²⁰20. Instituto de Evaluación Tecnológica en Salud. Manual de evaluación para la incorporación de tecnologías sanitarias en instituciones prestadoras de servicios de salud. Bogotá: IETS; 2022.).

The third most cited barrier identified by this scoping review was financial support. Although almost half of the studies did not report the source of financial support, different financing sources were identified. At least part of the identified financial support was from sources such as grants and external funding (¹³13. de Soárez PC, Pepe VLE, Novaes HMD. Hospital-based health technology assessment in Brazil: current experiences and challenges. Int J Technol Assess Health Care. 2021;37(1):e86. https://doi.org/10.1017/S0266462321000581.
https://doi.org/10.1017/S026646232100058... , ²⁶26. Pereira CC de A, Rabello R dos S, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care. 2017;33(2):227–231. https://doi.org/10.1017/s0266462317000459.
https://doi.org/10.1017/s026646231700045... , ³³33. Trindade EM. Incorporação e avaliação de novas tecnologias no sistema de serviços de saúde brasileiro: estudo de caso na área de cardiologia [Thesis]. São Paulo: Universidade de São Paulo; 2006. https://doi.org/10.11606/T.5.2006.tde-22112006-131244.
https://doi.org/10.11606/T.5.2006.tde-22... , ³⁵35. Francisco F de R. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais [Dissertation]. São Paulo: Escola de Administração de Empresas de São Paulo; 2017. Available from: https://hdl.handle.net/10438/18165.
https://hdl.handle.net/10438/18165... ). As discussed, seasonality in financing may partially explain the predominance of part-time staff in HB-HTA. Other challenges identified, even less frequently cited, were inappropriate physical space (²⁷27. Stopatto DH de S, Elias FTS. Núcleos de Avaliação de Tecnologias em Saúde e Comissões de Farmácia e Terapêutica em hospitais universitários: organização e articulação. HU Rev. 2023;49:1–10. https://doi.org/10.34019/1982-8047.2023.v49.41198.
https://doi.org/10.34019/1982-8047.2023.... ), scarcity of material and resources (²⁷27. Stopatto DH de S, Elias FTS. Núcleos de Avaliação de Tecnologias em Saúde e Comissões de Farmácia e Terapêutica em hospitais universitários: organização e articulação. HU Rev. 2023;49:1–10. https://doi.org/10.34019/1982-8047.2023.v49.41198.
https://doi.org/10.34019/1982-8047.2023.... , ²⁹29. Cohen M, Lima AF, Miguel S, Aziz M, Cardoso RB, Cruz L. PP99 Hospital-based health technology assessment units in Brazil: present and future. Int J Technol Assess Health Care. 2019;35(S1):56–57. https://doi.org/10.1017/S0266462319002344.
https://doi.org/10.1017/S026646231900234... , ³⁰30. Taype-Rondan A, Soriano-Moreno DR, Quincho-Lopez A, Martinez-Rivera RN, Mejia JR, Timaná-Ruiz R. Características metodológicas de las evaluaciones de tecnologías sanitarias elaboradas en Perú, 2019-2021. Rev Cuerpo Med HNAAA. 2022;15(Supl. 1). Available from: https://cmhnaaa.org.pe/ojs/index.php/rcmhnaaa/article/view/1435.
https://cmhnaaa.org.pe/ojs/index.php/rcm... ), lack of structured processes (¹⁹19. Galdino JPDS, Camargo EB, Elias FTS. Sedimentação da avaliação de tecnologias em saúde em hospitais: uma revisão de escopo. Cad Saude Publica. 2021;37(9):e00352520. https://doi.org/10.1590/0102-311x00352520.
https://doi.org/10.1590/0102-311x0035252... , ²⁴24. Oliveira FAM de. Incorporação de equipamentos médicos hospitalares no Sistema Único de Saúde (SUS): Um Estudo de Caso da aquisição de Equipamento de Diagnóstico por Imagem [Dissertation]. Rio de Janeiro: Instituto Nacional de Cardiologia; 2021. Available from: https://dspace.inc.saude.gov.br/items/c6a1e93b-b7de-4e58-822b-7d9807bcba99/full.
https://dspace.inc.saude.gov.br/items/c6... , ²⁵25. Silva Rodrigues AK, De Oliveira Júnior LB, Pereira dos Santos LF, Dos Santos Jaernevay ML. Diagnóstico situacional de um hospital universitário de Minas Gerais a partir dos resultados do processo de avaliação interna da qualidade. HU Rev. 2022;48:1–11. https://doi.org/10.34019/1982-8047.2022.v48.34666.
https://doi.org/10.34019/1982-8047.2022.... , ²⁸28. Lima RA, Brazorotto JS. Análise situacional da incorporação de tecnologias em hospitais públicos federais no Brasil. Enferm Foco. 2023;14:e-202343. https://doi.org/10.21675/2357-707X.2023.v14.e-202343.
https://doi.org/10.21675/2357-707X.2023.... ), problems of internal communication (²⁷27. Stopatto DH de S, Elias FTS. Núcleos de Avaliação de Tecnologias em Saúde e Comissões de Farmácia e Terapêutica em hospitais universitários: organização e articulação. HU Rev. 2023;49:1–10. https://doi.org/10.34019/1982-8047.2023.v49.41198.
https://doi.org/10.34019/1982-8047.2023.... , ³³33. Trindade EM. Incorporação e avaliação de novas tecnologias no sistema de serviços de saúde brasileiro: estudo de caso na área de cardiologia [Thesis]. São Paulo: Universidade de São Paulo; 2006. https://doi.org/10.11606/T.5.2006.tde-22112006-131244.
https://doi.org/10.11606/T.5.2006.tde-22... ), low recognition of HTA results (¹⁹19. Galdino JPDS, Camargo EB, Elias FTS. Sedimentação da avaliação de tecnologias em saúde em hospitais: uma revisão de escopo. Cad Saude Publica. 2021;37(9):e00352520. https://doi.org/10.1590/0102-311x00352520.
https://doi.org/10.1590/0102-311x0035252... ), and political interference (³⁸38. Attieh R, Gagnon M-P. Implementation of local/hospital-based health technology assessment initiatives in low- and middle-income countries. Int J Technol Assess Health Care. 2012;28(4):445–451. https://doi.org/10.1017/s026646231200058x.
https://doi.org/10.1017/s026646231200058... ).

It is most likely that some of the barriers identified in this review could be overcome based on the experience of international HTA agencies or networks. The AdHopHTA handbook, for instance, is the document closest to a best-practices guide for organizing and performing local-based HTA. Of course, adapting to the reality of different contexts must be considered. Fomenting debate about HB-HTA is another strategy that needs to be followed. The example of the Canadian Agency for Drugs and Technologies in Health (CADTH), which promoted the Hospital/Regional HTA Symposium in 2013 that brought together eminent specialists to present and debate local evidence-based decisions for healthcare sustainability, is another initiative that can be considered as a reference for emergent HB-HTA scenarios. The national and international networks in LAC can take inspiration from the initiatives of the HTAi, which promoted webinars such as the 2021 Rapid Assessment and the HB-HTA Annual Business Meeting.

Limitations

This review identified 17 studies and two institutional documents regarding HB-HTA in LAC. However, no study was found among the Caribbean countries, and most of the studies originated from the Brazilian context. Consequently, caution is needed when interpreting the results as representative of the broader LAC region. The nature of this review only provides an overview of the situation of HB-HTA in LAC. It mapped the existing literature related to HB-HTA in LAC. The absence of evidence does not mean that no HB-HTA is being carried out in some parts of the region, but it does suggest that there is potential to grow.

Conclusion

The unevenly distributed evidence about applying HTA processes at a local level suggests that HB-HTA is still in the early stages in LAC. Particular attention should be given to the Caribbean context, where no study was found. Private or philanthropic institutions may benefit from implementing HTA processes, improving the distribution of economic resources to manage the value of health technology at the local level. At the same time, sharing their experiences may help present solutions in a private healthcare context. Hiring full-time staff and providing specialized training is vital for increasing HB-HTA in LAC. For this reason, financial support is a significant challenge to overcome.

Disclaimer.

Authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the RPSP/PAJPH and/or PAHO.

Acknowledgments.

The authors acknowledge Malén Hollmann and Alexandre Lemgruber from the Pan American Health Organization (PAHO) for their help conceptualizing this for the Health Technology Assessment Network of the Americas (RedETSA).

REFERENCES

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