Advancing Health Technology Assessment MENA: Insights and Implications for the Region

In this article we provide an update on the current state of Health Technology Assessment (HTA) across the Middle East and North Africa (MENA) region. Health Technology Assessment MENA remains at an early stage of development despite its vital role in evaluating the medical, economic, ethical, and societal impacts of health interventions to support evidence-based pricing, reimbursement, and procurement decisions.

Scoping Review Reveals Limited Formal Structures

A recent study completed a scoping review of 39 publications covering 17 MENA countries, supplemented by expert insights from the 2023 Tailored Reimbursement for Innovative and Generic Essential Remedies (TRIGER) meeting, identified formal HTA structures in only a few nations. Tunisia established the oldest national HTA body (National Instance of Evaluation and Accreditation in Health – INEAS) in 2012, followed by more recent formal or semi-formal initiatives in Saudi Arabia and Egypt.

Wide Variation in HTA Maturity

HTA implementation varies widely across the region, with leading countries incorporating Health Technology Assessment MENA into pricing and reimbursement processes while others rely on fragmented, institutional-level approaches. Experts at the TRIGER meeting emphasized the need for nationally tailored HTA entities, capacity building, and regional collaboration to accelerate adoption and improve healthcare outcomes.

Disparity in Institutionalization and Tools

The most impactful insight is the marked disparity in HTA institutionalization among MENA countries. Tunisia, Saudi Arabia, and Egypt demonstrate the highest level of formalization, with dedicated bodies supported by legislation and routine use in decision making. Value-based pricing is applied in six countries, though often on a non-mandatory or case-specific basis. Multi-criteria decision analysis (MCDA) is gaining traction as a supplementary tool, particularly for purchasing off-patent pharmaceuticals, orphan drugs, and medical devices.

Mixed-Methods Evidence Synthesis

The study employed a mixed-methods design combining a scoping literature review with expert deliberation. The review systematically searched Embase, PubMed, gray literature, and national authority websites. Expert input from the TRIGER meeting served both to update literature findings and to generate 12 consensus recommendations, including customization of HTA to local contexts, establishment of national entities, and sustainable funding mechanisms.

Strategic Implications for Market Access and HEOR

The findings carry significant implications for reimbursement strategies across the MENA region. The observed heterogeneity underscores the importance of context-specific HTA frameworks. For pharmaceutical manufacturers and market access teams, the growing use of MCDA tools, and managed entry agreements signals a shift toward holistic value demonstration.