OBJECTIVES: This study aimed to analyze and compare the main decision factors of recommendations for the incorporation of new health technologies done by CONITEC (Brazil), NICE (England), CADTH (Canada), PBAC (Australia), HAS (France), IQWiG (Germany).

METHODS: Method: 15 technologies were selected, including rare diseases, oncology, and immune therapies, including onasemnogene abeparvovec, abemaciclib, palbociclib, ribociclib, alemtuzumab, certolizumab, crizotinib, dapaglifozin, nivolumab, pembrolizumab, nusinersen, ocrelizumab, riociguat, tocilizumab, and vedolizumab. The HTA reports were retrieved from each HTA agency website, and the recommendation reports were analyzed and compared regarding similarity or divergence from the Brazilian agency, considering five decision factors: disease, technology, clinical and economic evidence, and the health system. In addition, a discourse analysis was performed to assess the recordings of Conitec deliberation meetings (preliminary and final).

RESULTS: NICE, CADTH, PBAC, IQWiG, and HAS incorporated all the 15 drugs analyzed (until the end date of this search, dapagliflozin and tocilizumab, and certolizumab and tocilizumab have not been assessed by CADTH and IQWiG, respectively. Conitec diverged from other agencies for certolizumab, riociguat, ocrelizumab, and vedolizumab, and for those drugs incorporated, it took between 1 and 7 years more than the first incorporation in one of the other countries analyzed.

The Conitec discourse analysis has shown that some decisions went against the aspects discussed at the meeting and technical (clinical and economic) evidence presented in the final HTA report, suggesting the influence of decision factors, such as political and social media.

CONCLUSIONS: The comparison between HTA agencies highlight the relevance of transparency in the HTA process. In this sense, understanding the HTA and health decision-making process in Brazil is essential to improve accountability, aiming for a better use of public resources.