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Why do health technology assessment drug reimbursement recommendations differ between countries? A parallel convergent mixed methods study


  • Nicod, Elena
  • Maynou, Laia
  • Visintin, Erica
  • Cairns, John


Using quantitative and qualitative research designs, respectively, two studies investigated why countries make different health technology assessment (HTA) drug reimbursement recommendations. Building on these, the objective of this study was to (a) develop a conceptual framework integrating the factors explaining these decisions, (b) explore their relationship and (c) assess if they are congruent, complementary or discrepant. A parallel convergent mixed methods design was used. Countries included in both previous studies were selected (England, Sweden, Scotland and France). A conceptual framework that integrated and organised the factors explaining the decisions from the two studies was developed. Relationships between factors were explored and illustrated through case studies. The framework distinguishes macro-level factors from micro-level ones. Only two of the factors common to both studies were congruent, while two others reached discrepant conclusions (stakeholder input and external review of the evidence processes). The remaining factors identified within one or both studies were complementary. Bringing together these findings contributed to generating a more complete picture of why countries make different HTA recommendations. Results were mostly complementary, explaining and enhancing each other. We conclude that differences often result from a combination of factors, with an important component relating to what occurs during the deliberative process.

Suggested Citation

  • Nicod, Elena & Maynou, Laia & Visintin, Erica & Cairns, John, 2020. "Why do health technology assessment drug reimbursement recommendations differ between countries? A parallel convergent mixed methods study," Health Economics, Policy and Law, Cambridge University Press, vol. 15(3), pages 386-402, July.
  • Handle: RePEc:cup:hecopl:v:15:y:2020:i:3:p:386-402_7

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    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 6th July 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-07-06 11:00:00


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    Cited by:

    1. Anderson, Michael & Drummond, Michael & Taylor, David & McGuire, Alistair & Carter, Paul & Mossialos, Elias, 2022. "Promoting innovation while controlling cost: The UK's approach to health technology assessment," Health Policy, Elsevier, vol. 126(3), pages 224-233.
    2. Mackenzie Mills, 2023. "HTA Barriers for Conditional Approval Drugs," PharmacoEconomics, Springer, vol. 41(5), pages 529-545, May.

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