OBJECTIVES: The overarching purpose of health technology assessment (HTA) agencies globally is to make evidence-based evaluations of the value added by new health interventions. Increasingly, HTA agencies ask manufacturers to include reference to health equity in their submissions. This study aims to understand how frequently HTA agencies (in Europe, Canada and Australia) ask manufacturers to provide evidence relating to health equity, and how frequently they refer to that evidence in their assessment reports.

METHODS: A systematic comparison of HTA agency guidance (including submission templates) and assessment reports was undertaken. Specific evaluation was performed to assess the equity-related elements of value that are referenced in HTA guidance documents and reports relating to 5 pharmaceuticals assessed between January 2022 and June 2024. We considered elements of value in two broad categories; therapy area-related value (e.g. investment in indications that disproportionately impact vulnerable or underserved populations) and intervention-related value (including clinical trial diversity, patient support initiatives, and intrinsic features of the intervention that may impact equitable access).

CONCLUSIONS: Our analysis found that several HTA agencies refer to health equity in their guidance. In certain assessments they call out equity considerations as value detractors, value drivers or calls to action. The frequency with which equity is referenced within assessment reports varies between countries; CADTH is a leading agency in terms of the frequency with which health equity is explicitly included in the decision-makers’ deliberations. Going forward, it will be key for HTA agencies to go beyond asking for health equity-related evidence, and demonstrate how they are using that evidence in their deliberations.