Abstract The Middle East and North Africa (MENA) region faces growing pressure on health systems due to rising burdens of noncommunicable diseases, increasing healthcare costs, and expanding access to innovative health technologies. Health technology assessment (HTA) is increasingly recognized as a critical tool to support transparent and efficient resource allocation; however, HTA institutionalization and capacity vary widely across the region. This Perspective article examines the potential for meaningful regional HTA collaboration, drawing on insights from a panel discussion co-organized by HTAi and the ISPOR UAE Chapter in early 2026, and situating these reflections against the long-standing experience of European HTA cooperation. While acknowledging fundamental structural and governance differences between MENA and the European Union, the article identifies transferable lessons, enabling conditions, and pragmatic entry points for collaboration, such as clinical evidence generation initiatives and early scientific engagement with technology developers. It argues for an incremental, trust-based approach focused on high-value, transferable HTA components aimed at strengthening national HTA systems rather than replacing them.
Abstract Patient engagement in the health technology and pharmaceutical regulation space can be instituted both in the feedback process regarding particular health technologies, as well as in broader decision making, such as those related to institutional features. In this commentary, we offer an analytical reflection on the ethics and political economy of patient engagement in Canadian institutional decisions among Canada’s five primary pharmaceutical and health technology regulatory and advisory agencies. The article begins by addressing motivations behind including patients and members of the public in institutional decision making. We introduce a framework for understanding the ethical reasons why institutions choose to engage the public and patients, and the challenges they face when doing so. The commentary gives an overview based on publicly available data of patient and public engagement practices at Canada’s five primary health technology regulatory and advisory agencies: Health Canada; the Canadian Agency for Drugs and Technologies in Health, now known as Canada’s Drug Agency; Institut national d’excellence en santé et en services sociaux ; the Patented Medicine Prices Review Board; and the pan-Canadian Pharmaceutical Alliance. Key trends across the five institutions are addressed, including an overall preference for the inclusion of patients in institutional decisions over technology-specific decisions. We suggest the development of a more coordinated approach to patient and public engagement in Canadian pharmaceutical and health technology decision making, guided by an understanding of the political economy of ethical priorities we have described.
Shortage of healthcare professionals is a major challenge for healthcare systems in many countries. The problem is expected to further increase due to demographic changes, with a rising percentage of elderly patients with multiple chronic conditions. Digital health technologies (DHTs) are proposed as a strategy to tackle this challenge by saving clinician time. However, guidelines for health economic evaluation of DHTs remain generally unchanged in most countries, with the main focus on the clinical impact and estimation of the incremental cost-effectiveness ratio (ICER), with limited interest in the impact of digital technologies on clinical staff.Objectives The objective of this article is to present arguments and examples of practical tools for adjusting economic evaluations and Health Technology Assessment (HTA) to ensure that assessments of DHTs reflect current demographic challenges.Methods The arguments are based on a narrative review of studies of the effects of DHTs on health care professionals' workload and use of time.Results Based on the review, three recurring themes were identified: (1) the different definitions of effects on clinician time, (2) the need for quantitative assessment of effects on clinician time, and (3) the different kinds of effects on clinician time.Conclusion On this basis, two suggestions for adjustment of economic evaluations and HTA are presented: by the collection of data and presentation of results on the effects of DHTs on Time Needed to Treat (TNT), and by the use of shadow prices to ensure that the costs of healthcare professionals are correctly reflected in the alternative costs.
