OBJECTIVES: The emergence of national health technology assessment (HTA) agencies has increased the use of economic evaluation. The objective is to develop a country-specific approach for conducting economic evaluation as a specific component of HTA to determine the value for money of new interventions.

METHODS: A real-time Delphi survey was conducted using 17 items from the method component of the CHEERS II as the foundation of the Saudi guidelines. The consensus was obtained for the relevance of the guidelines recommendations to the Saudi healthcare system. We set a threshold of 80% for agreement and an interquartile range less than three, on a 9-point Likert scale. An interim analysis provided feedback for recommendations of items where there was “no consensus”. A natural language process (NLP) approach was employed to investigate the relationship between experts’ comments and consensus decisions.

RESULTS: A total of 78% participated, with an average response progress rate of 97.2%. The interim analysis provided a 63% adjustment rate for recommendations, with the majority requiring further clarification (65%). The guidelines concluded with a consensus on 76% of the recommendations, while four remained undetermined, including the choice of discount rate, using the same rate for both health benefits and costs, outcome selection and gross costing. The NLP results supported the consensus decision.

CONCLUSIONS: The expert consensus contributed to the development of informative guidelines relevant to the KSA. The guideline serves as a reference case, providing a foundation for HTA practices, reimbursement decisions and future research for the KSA and neighbouring countries.