Health Technology Assessment Programme for Iran; A Luxury or Real Need?

Health Technology Assessment (HTA) is increasingly being utilized on a global scale to improve the clinical and cost-effectiveness of healthcare resource utilization. The aim of this study was to address the need of a HTA system for Iranian health system. This study was a needs assessment study which performed in four steps. Firstly, a comprehensive review and semi-structured interviews were undertaken to identify challenges, nature and the context of health system in Iran in which the system of HTA would be applied. Secondly, a detailed analysis of individual aspects of the Iranian healthcare system was done to realize the roots and the sources of the problems. Thirdly, a wide-range review was undertaken to understand the concept, philosophy and the aim of a HTA system as one of the potential solutions to improve Effectiveness, Efficiency, and Equity (EEE) of healthcare delivery system in Iran. Finally, the priority and extent to which the introduction of HTA to Iran would assist in achieving the objectives of the Iranian healthcare system was assessed. The review and the 38 interviews with key informants identified that healthcare delivery, health insurance, and pharmaceutical systems have faced serious EEE problems. These problems are originated from both structural deficiency and healthcare policies; the policies which were based mainly on pressure rather than evidence. The review of the literature illustrated that the main aim of HTA development was to improve the EEE of the healthcare system. Nevertheless to ensure such improvement, it is necessary to consider to the context of a health system. Development of a HTA system in Iran would enhance the development of clinical guidelines as well as economic evaluation studies. It could also improve managing new health technologies in some ways. Nonetheless focusing on the sources of inefficiency and inequity of the health system (policy and planning) could improve the efficiency of the system more effectively and thus is more cost-effective. This could also provide an appropriate context for an effective HTA system within the health system in Iran.