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Unleashing the potential: the imperative of political support for health technology assessment in Iran

Health Economics Review volume 14, Article number: 84 (2024) Cite this article

Abstract

Health Technology Assessment (HTA) is essential for evidence-based healthcare decision-making, yet its integration into Iran’s healthcare system faces political and logistical challenges. Despite HTA’s potential to improve resource allocation, limited awareness, data gaps, and competing priorities hinder its implementation. This commentary emphasizes the need for political support, advocating capacity-building, collaboration, and alignment with long-term health policies. Leveraging international partnerships and monitoring outcomes can enhance HTA’s role in improving healthcare in Iran and contributing to global health advancements.

Background

Healthcare systems globally are under pressure to allocate resources effectively while managing budgetary constraints [1]. Health technology assessment (HTA) has become essential in guiding evidence-based healthcare decisions [2]. HTA evaluates the clinical, economic, and social impacts of health technologies, offering insights to policymakers for informed decisions on the adoption and pricing of medical innovations [3]. While HTA has gained traction in many developed countries, its implementation in developing nations remains complex, with political support being a key determinant [4].

Iran, with its rich history of healthcare advancements, has made commendable progress in expanding access to medical services [5]. Recent efforts to strengthen healthcare infrastructure demonstrate the country’s commitment to addressing public health challenges [6]. However, the successful integration of new health technologies in Iran requires a systematic approach, driven by political commitment to HTA [7]. Political backing is essential to establish HTA institutions, foster collaboration, and incorporate HTA findings into policy discussions, enhancing transparency and accountability in healthcare resource allocation [8].

Despite Iran’s healthcare progress, political, economic, and social factors influence how health technologies are prioritized and resources allocated [9]. As healthcare policymaking is inherently interdisciplinary, effective coordination among ministries, regulatory bodies, and healthcare providers is necessary to implement HTA fully. This commentary explores the challenges of HTA implementation in Iran, emphasizing the need for consistent political support to overcome these obstacles [10].

Political landscape and support for HTA

Iran operates under a unique political system, combining elements of both a theocracy and a republic. The Supreme Leader holds significant authority, while elected officials, including the President and Parliament (Majlis), are responsible for making and implementing policies [11]. In healthcare policymaking, various actors and institutions shape decisions, including the Ministry of Health and Medical Education (MOHME), which oversees healthcare policies and regulates the pharmaceutical and medical device industries [12].

Although the government has expanded healthcare services, integrating evidence-based decision-making, such as HTA, into policy processes has faced obstacles. Political interests often influence resource allocation and the prioritization of health technologies [13]. The level of political support for HTA is influenced by several factors, including healthcare priority-setting, budgetary constraints, public perception, and international collaboration [8].

Benefits of political support for HTA

Political support for HTA provides policymakers with evidence-based information about the clinical and economic impact of health technologies, enabling informed decisions on technology adoption, funding, and prioritization [14]. This ensures efficient use of limited resources, directing them toward interventions that offer the greatest benefit [15]. Key benefits include:

  1. 1.

    Informed policymaking: Political backing ensures that policymakers base their decisions on robust evidence, improving the adoption and funding of health technologies [16].

  2. 2.

    Resource optimization: HTA aids in the rational allocation of healthcare resources, promoting cost-effective interventions and sustainable healthcare systems [17].

  3. 3.

    Transparency and accountability: Political support fosters a transparent healthcare system where decisions are grounded in objective HTA studies, reducing the influence of vested interests [18].

  4. 4.

    Collaboration and stakeholder engagement: Political backing encourages collaboration between policymakers, healthcare providers, and researchers, leading to better-informed HTA studies and greater uptake of recommendations [19].

  5. 5.

    Improved access to innovation: With political support, HTA can accelerate the evaluation and adoption of novel technologies, benefiting patients with unmet medical needs [20].

  6. 6.

    Economic efficiency: HTA promotes the use of cost-effectiveness data in decision-making, leading to significant cost savings for the healthcare system [21].

  7. 7.

    Global alignment: Political support aligns Iran’s healthcare decision-making with international best practices, enhancing its position in global health networks [22].

Challenges and barriers

Although HTA holds immense potential, several challenges and barriers impede its full implementation in Iran. These challenges can be grouped into broader categories:

  1. 1.

    Economic and political challenges: Competing demands for limited resources and political priorities often overshadow long-term investments in HTA [23]. Policymakers must balance various healthcare needs, and HTA initiatives may face competition for funding amidst other pressing issues [24].

  2. 2.

    Lack of awareness and understanding: Limited awareness of HTA’s benefits among policymakers can hinder its integration into healthcare decision-making [25]. Without a clear understanding of HTA principles, decision-makers may be hesitant to endorse or fund HTA initiatives [26].

  3. 3.

    Data availability and quality: TA relies on comprehensive data to assess the clinical and economic impacts of health technologies [48]. However, inadequate or poor-quality data may limit the scope of assessments, making it difficult to produce meaningful results [47].

  4. 4.

    Institutional capacity and expertise: Building and maintaining HTA capacity within governmental institutions requires skilled experts in health economics and epidemiology [2]. A lack of adequate expertise and institutional support can delay HTA implementation [40].

  5. 5.

    Stakeholder resistance: Resistance from industry stakeholders is common, especially when HTA recommendations are unfavorable to specific technologies [41]. Conflicting interests within MOHME may also contribute to resistance [42].

  6. 6.

    Policy receptivity and timing: Policymakers’ receptiveness to HTA findings may depend on political timing and priorities [43]. Short-term political goals may not always align with the long-term benefits of HTA, limiting its impact on decision-making [44].

  7. 7.

    Socioeconomic factors: Cultural beliefs, public perceptions, and social inequalities may influence how HTA findings are received and implemented, especially in addressing diverse healthcare needs [45].

  8. 8.

    Fragmented healthcare system: Iran’s healthcare system is fragmented, with multiple stakeholders involved at various levels [46]. Coordinating these stakeholders to support HTA implementation can be challenging [47].

Recommendations

To overcome these challenges and maximize HTA’s benefits, several steps can be taken:

  1. I.

    Political advocacy and awareness: Advocates of HTA must engage policymakers through targeted campaigns, workshops, and educational programs [36]. These efforts will raise awareness of HTA’s role in evidence-based decision-making, demonstrating its value in achieving healthcare goals [18].

  2. II.

    Strengthening HTA capacity: Investing in HTA capacity within governmental institutions is crucial [37]. This includes recruiting experts, providing training, and ensuring access to necessary resources and infrastructure [38].

  3. III.

    Collaboration and knowledge sharing: Foster collaboration between HTA researchers, policymakers, and healthcare providers through regular knowledge-sharing forums [39]. These interactions can enhance understanding and support for HTA’s role in decision-making [40].

  4. IV.

    Policy alignment: Integrate HTA findings into Iran’s broader health policy framework [41]. Encouraging policymakers to use HTA as a guiding tool for resource allocation will strengthen evidence-based decision-making [42].

  5. V.

    Stakeholder engagement: Involving patient advocacy groups, healthcare providers, and industry representatives early in the HTA process will improve the quality of assessments and increase acceptance of HTA recommendations [43].

  6. VI.

    Data improvement: Improve data infrastructure and accessibility, ensuring relevant data is available for HTA assessments [44]. This will ensure HTA recommendations are based on robust evidence [45].

  7. VII.

    International collaboration: Engage with international HTA organizations to access best practices, share knowledge, and collaborate on joint research efforts. International partnerships can help enhance Iran’s HTA capabilities [13].

  8. VIII.

    Incentives for adoption: Consider financial or policy incentives to encourage the adoption of HTA recommendations, such as preferential reimbursement for interventions that demonstrate cost-effectiveness [46].

  9. IX.

    Evaluation mechanisms: Establish systems to monitor HTA’s impact on healthcare decision-making and patient outcomes [47]. Regular evaluations and stakeholder feedback will help refine the HTA process [48].

Conclusion

The successful implementation of HTA in Iran hinges on strong political support and collaboration. HTA has the potential to transform healthcare decision-making, optimizing resource allocation and improving patient outcomes. Overcoming the challenges requires sustained political commitment, capacity building, and strategic alignment with long-term health policies. With these elements in place, HTA can be a driving force for a more equitable, efficient, and patient-centered healthcare system in Iran. By adopting these recommendations, Iran can position itself as a leader in healthcare innovation, benefiting its citizens and contributing to advancements in global health.

Data availability

Not applicable.

Abbreviations

HTA:

Health technology assessment

MOHME:

Ministry of Health and Medical Education

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Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK

    Aidin Aryankhesal

  2. Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran

    Meysam Behzadifar & Masoud Behzadifar

  3. Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Ahad Bakhtiari

  4. Hospital Management Research Center, Health Management Research Institute, University of Medical Sciences, Tehran, Iran

    Samad Azari

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Contributions

MeB, MaB and AA designed the study. AB, SA, AA and MaB collected the data and performed the data analysis. MaB and NLB edited and revised the paper for grammar. All authors read and approved the final paper for publication.

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Correspondence to Masoud Behzadifar.

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Aryankhesal, A., Behzadifar, M., Bakhtiari, A. et al. Unleashing the potential: the imperative of political support for health technology assessment in Iran. Health Econ Rev 14, 84 (2024). https://doi.org/10.1186/s13561-024-00563-x

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Health Economics Review

ISSN: 2191-1991

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