Adapting Global HTA Models for Local Impact: A Pathway for Low- and Middle-Income Countries (LMICs)

Across the world, rapid population growth, a rising burden of non-communicable diseases, and economic constraints mean that governments must make tough choices about which medicines, technologies, and interventions to fund. Health Technology Assessment (HTA) has emerged as a powerful tool to guide decision-making in healthcare.

But while HTA has matured in high-income countries (HICs), its frameworks are often designed for contexts with abundant resources, strong data systems, and well-established regulatory environments. For low- and middle-income countries (LMICs), adopting these models wholesale can be impractical, or even counterproductive.

The real opportunity here lies in adapting global HTA models to local realities, ensuring that they support equity, sustainability, and community needs. 

Why Global Frameworks Alone Aren’t Enough

Countries like the UK, Canada, and Australia have built HTA systems that are admired worldwide. Agencies such as NICE (UK) and CADTH (Canada) have set good benchmarks in evidence-based health policy. Their frameworks prioritize rigorous data, robust modeling, and long evaluation cycles.

However, LMICs often face distinct challenges:

• Resource constraints – Health budgets are limited, making affordability a critical lens.

• Data gaps – Reliable local epidemiological and cost data are scarce, complicating traditional HTA modeling.

• Health system realities – Informal providers, fragmented supply chains, and varied cultural practices affect how care is delivered.

• Equity concerns – Interventions must reach rural, marginalized, and vulnerable groups, not just urban populations.

This context calls for flexibility, where global best practices provide structure but not a straightjacket.

Principles for Local Adaptation

1. Simplify Without Losing Rigor: LMICs don’t need to replicate the exhaustive processes of established HTA agencies. Streamlined, “fit-for-purpose” assessments can deliver actionable insights without overwhelming limited systems. For example, rapid HTAs or tiered evidence requirements can help countries move faster on critical decisions.

   
   

2. Prioritize Equity and Access: While cost-effectiveness is a key criterion in HIC models, LMICs must weigh equity more heavily. A vaccine that prevents illness in remote rural populations may deliver transformative impact, even if the cost per QALY (quality-adjusted life year) is less favorable by global standards.

   
   

3. Build on Regional Collaboration: Many LMICs face similar health burdens, malaria, tuberculosis, maternal mortality. Regional HTA networks (e.g., in Africa, Asia, and Latin America) can share methods, data, and evidence synthesis to reduce duplication and speed up decision-making.

   
   

4. Leverage Local Data Sources: Household surveys, community health worker records, and national health insurance claims can substitute for the lack of large, longitudinal datasets. The goal is not perfection but relevance.

   
   

5. Engage Stakeholders Early: Effective HTA in LMICs must include voices beyond economists and clinicians. Patient groups, civil society, and community leaders help ensure that cultural realities and lived experiences inform decisions.

Local Success Stories

• South Africa: South Africa’s National Department of Health issued Pharmacoeconomic Guidelines (2012/13; update underway) and an HTA Methods Guide (2023) to tailor assessments to national priorities.

  
  

• Thailand: Through its Health Intervention and Technology Assessment Program (HITAP), Thailand developed a strong HTA system rooted in local data and stakeholder participation, serving as a regional role model.

  
  

• Kenya: Kenya is progressing but not yet institutionalized, with ongoing capacity-building and introductory HTA programs.

These examples show that LMICs can adapt rather than adopt global HTA models, making them tools for transformation rather than templates.

The Road Ahead

As LMICs advance toward UHC, HTA will become increasingly central in determining what gets funded, who gets access, and how scarce resources are allocated. By adapting global frameworks to local contexts, countries can drive evidence-informed priority-setting, improve accountability and transparency in health spending, and ensure that investments deliver not just efficiency, but also equity and fairness.