Assessing the performance of health technology assessment (HTA) agencies: developing a multi-country, multi-stakeholder, and multi-dimensional framework to explore mechanisms of impact

Abstract Background Health technology assessment (HTA) agencies have an important role to play in managing the rising demands on health systems. However, creating and running such potentially diverts resources from frontline services. A large number of studies address question ‘what is impact HTA?’. Several points heterogeneity this literature include: purpose study, definition HTA, impact, scope rigour evaluations. Our study seeks several limitations literature. This aims explore mechanisms HTA agency. In doing so, we consider as institution rather than a knowledge product build evaluation framework international, multi-stakeholder multi-dimensional perspective. Methods We conducted 9 key informant interviews with experts international community. addressed questions, informed by existing frameworks within literature, understand their perspectives analyse data using logic modelling mapping, tools visualise change. Findings mapping highlights distinct, but not necessarily mutually exclusive, through which overall agency achieved. These are: effective conduct studies; use agenda-setting policy formulation processes; engagement external communications; good institutional reputation fit healthcare policy-making system; tool for negotiation prices; implementation change regarding technologies. also identify indicators these effects. Conclusions findings resulting complement add offering new perspective generate impact. considers product, multi-dimensional, includes views. hope analysis will be useful countries interested performance.