The findings of this examine make clear the challenges and alternatives surrounding the event of HTA in Iran, utilizing Kingdon’s Multiple Streams Framework to investigate the difficulty. Based on the evaluation of the participant quotes and the ideas of Kingdon’s Multiple Streams Framework, the event of HTA in Iran seems to be on the agenda, however not but absolutely applied or prioritized on the mandatory ranges. The findings exhibit that Iran, like many different international locations, faces important challenges in absolutely growing HTA, but in addition has key alternatives to leverage for progress.
Problem stream
The rising prices of healthcare, significantly regarding imported medical applied sciences, have turn out to be a major challenge in Iran, mirroring world issues in regards to the effectivity of healthcare useful resource allocation. As highlighted by the contributors in our examine, these monetary pressures are amplified in international locations with useful resource constraints, the place the necessity to optimize healthcare spending is important. For occasion, international locations like Brazil, South Africa, and China have confronted related challenges, resulting in the popularity of HTA as a significant device for addressing inefficiencies and making certain cost-effectiveness in healthcare [26, 27].
In South Africa, the implementation of HTA has helped deal with disparities in entry to important medical applied sciences, particularly within the context of choosing drugs for the National Essential Medicines List. The institutionalization of HTA in South Africa has been a strategic response to useful resource constraints, facilitating the cost-effective number of medicines [27]. While this method has yielded optimistic outcomes, our examine discovered that Iran faces extra important structural limitations, primarily attributable to financial sanctions and political dynamics. Unlike South Africa, which has efficiently built-in HTA into its coverage frameworks, Iran’s progress has been hindered by these distinctive contextual challenges [28].
China, equally, has acknowledged the significance of HTA as a response to rising healthcare prices and an getting older inhabitants. In distinction to Iran, China has efficiently used HTA to tell nationwide insurance policies such because the National Reimbursement Drug List (NRDL), which has been central to creating evidence-based selections on which applied sciences to incorporate of their medical insurance system [29]. While each international locations share frequent challenges, China’s extra centralized, top-down method to HTA implementation contrasts sharply with Iran’s fragmented healthcare system, offering useful insights into the function of political landscapes in shaping HTA effectiveness [30].
The Covid-19 pandemic has additional highlighted the urgency of integrating HTA into healthcare programs. In international locations just like the UK and Germany, HTA performed a central function in managing the disaster and making certain cost-effective responses to the pandemic [31]. However, in Iran, the pandemic has acted extra as a catalyst for dialogue about HTA moderately than as a immediate for instant coverage reform. This means that whereas there’s an growing recognition of HTA’s potential, its adoption in Iran stays gradual, hindered by structural and political challenges.
Policy stream
While HTA has been a subject of educational dialogue in Iran for a number of years, it has but to be built-in into formal well being coverage. The hole between theoretical discussions and coverage motion on HTA, as recognized by Iranian contributors, shouldn’t be distinctive to Iran. This hole between theoretical discourse and precise coverage motion is a typical problem in lots of international locations, the place the transition from tutorial data to coverage implementation is gradual. This hole was particularly evident within the case of South Africa, the place though HTA was mentioned extensively, the implementation of coverage frameworks was delayed attributable to political resistance [28].
The technical feasibility of implementing HTA in Iran, given the prevailing infrastructure in universities and analysis facilities, is promising. However, the findings underscore the necessity for political will to beat the resistance from non-public sector actors, significantly medical tools suppliers, who might view HTA as a risk to their enterprise pursuits. This dynamic illustrates a broader pressure between public well being targets and personal sector pursuits, a problem well-documented within the well being coverage literature. However, not like in Turkey and India, the place bureaucratic resistance has been recognized as a major barrier, our findings recommend that in Iran, political and sectoral resistance are the first elements stopping HTA from shifting into coverage [32, 33].
Countries like India and Turkey have additionally struggled with shifting HTA from tutorial discussions to formal coverage adoption [33, 34]. In India, regardless of the existence of educational analysis on HTA, the institutionalization of HTA into the well being ministry’s decision-making processes has confronted delays attributable to bureaucratic resistance and lack of coordination between stakeholders [33]. Similarly, Turkey’s HTA growth has been gradual, with political challenges and private-sector opposition hampering progress [34]. However, different international locations have managed to beat these limitations. For occasion, Thailand’s Health Intervention and Technology Assessment Program (HITAP) provides a mannequin the place HTA was efficiently built-in into nationwide coverage by securing robust political backing and aligning the method with nationwide well being objectives [35]. Iran may be taught from Thailand’s success in securing political buy-in, significantly in gentle of current authorities reforms that align extra intently with healthcare effectivity. The expertise of Thailand demonstrates the significance of political will and strategic advocacy, that are essential elements additionally emphasised by contributors in Iran.
Politics stream
The political atmosphere in Iran seems more and more conducive to the adoption of HTA, with a rising emphasis on healthcare effectivity and transparency. As highlighted by contributors, the growing political curiosity in effectivity and accountability in healthcare may create a supportive atmosphere for HTA adoption shortly [36].
The alignment of HTA with broader political objectives of bettering useful resource allocation and authorities accountability presents a major alternative for its growth [37]. However, the findings additionally spotlight the necessity for sustained advocacy to keep up momentum, significantly in gentle of current management modifications within the Ministry of Health.
A comparability with international locations like Chile and Mexico is helpful right here. In these nations, political shifts have created each challenges and alternatives for HTA adoption [3]. In Chile, HTA was built-in into broader healthcare reforms aimed toward bettering useful resource allocation, and in Mexico, related reforms have not too long ago began to bear fruit [38].
In Indonesia, the institution of the Indonesian Health Technology Assessment Committee (InaHTAC) in 2014 was a response to the necessity for higher transparency and accountability in healthcare spending [39]. Iran’s context, marked by political shifts, highlights the significance of advocacy in making certain HTA’s place on the political agenda.
Policy window and entrepreneurs
The identification of the Covid-19 pandemic and healthcare shortages as potential focusing occasions presents a key alternative for advancing HTA in Iran. As the findings recommend, these crises have uncovered vulnerabilities within the healthcare system, making the adoption of evidence-based decision-making frameworks extra urgent. Our examine discovered that whereas the pandemic offered alternatives for advancing HTA, it additionally emphasised the necessity for particular coverage entrepreneurs who can push the agenda ahead [40].
In the UK, the pandemic accelerated the function of HTA in evaluating new therapies and vaccines, reinforcing the significance of evidence-based decision-making [41]. In Germany, the Institute for Quality and Efficiency in Health Care (IQWiG) performed a central function in assessing new medical applied sciences through the pandemic, demonstrating the worth of HTA in crises [42].
The function of coverage entrepreneurs, as highlighted on this examine, is important to pushing HTA ahead. These people, whether or not within the Ministry of Health or tutorial establishments, are well-positioned to champion HTA, however they require extra visibility and institutional assist. This is very evident within the case of Taiwan, the place HTA confronted preliminary resistance however was step by step built-in into the National Health Insurance system attributable to strategic efforts by coverage entrepreneurs [43].
This aligns with Kingdon’s idea, which emphasizes the significance of coverage entrepreneurs in coupling the streams and seizing the coverage window when it arises. The lively function of those entrepreneurs in shaping the HTA agenda is important for advancing its implementation in Iran. This discovering aligns with different international locations’ experiences, similar to Australia, the place coverage entrepreneurs performed a major function in pushing for the institution of the Australian Medical Services Advisory Committee (MSAC), which now oversees HTA actions [44].
Limitations
While this examine offers useful insights, its limitations have to be acknowledged. The pattern measurement, whereas ample for qualitative evaluation, is comparatively small and should not absolutely seize the variety of views amongst all related stakeholders in Iran’s healthcare system. The small pattern measurement may restrict the generalizability of the findings to the broader inhabitants of healthcare professionals and policymakers in Iran. Additionally, potential biases in participant choice may have an effect on the illustration of sure stakeholder teams, significantly these with much less visibility or affect within the decision-making course of. For occasion, the inclusion of primarily tutorial or governmental stakeholders might not adequately symbolize the views of personal sector actors or marginalized communities.
Furthermore, whereas Kingdon’s Multiple Streams Framework offers a helpful lens for understanding coverage growth, future analysis may discover different theoretical fashions to offer a extra complete evaluation. Additionally, the concentrate on a single nation case examine limits the flexibility to match findings throughout totally different healthcare programs or coverage contexts. Further analysis can also be wanted to look at the particular steps required to combine HTA into Iran’s healthcare system and the potential challenges which will come up throughout its implementation.
Implications of growing HTA in Iran
Developing an HTA course of in Iran carries important implications for the inhabitants, the healthcare system, and the coverage panorama. These implications can play a pivotal function in advancing the effectiveness, fairness, and sustainability of healthcare supply within the nation.
Impact on inhabitantsImpact on healthcare system
Integrating HTA into Iran’s healthcare system will assist optimize useful resource allocation, scale back inefficiencies, and enhance the general efficiency of the system. As healthcare prices proceed to rise, HTA will allow policymakers to make knowledgeable selections about which well being applied sciences and interventions ought to be funded, thereby avoiding pointless expenditures on ineffective or low-priority therapies. This may end up in higher utilization of accessible assets, making certain that Iran’s healthcare system stays each financially sustainable and able to offering high-quality care.
Impact on coverage
HTA has the potential to remodel well being coverage decision-making in Iran by selling evidence-based policymaking. It can present policymakers with the required information to make knowledgeable decisions on well being expertise adoption, reimbursement insurance policies, and the design of nationwide healthcare applications. In the long run, this will result in extra clear and accountable decision-making processes, growing public belief within the healthcare system. Furthermore, the event of HTA may contribute to Iran’s efforts to combine with world well being requirements, bettering its positioning in worldwide well being boards.
Developing a proper HTA course of in Iran wouldn’t solely improve the effectivity and effectiveness of healthcare supply but in addition align the nation’s well being insurance policies with world finest practices, making certain that the healthcare system can meet the evolving wants of its inhabitants.
To synthesize the important thing suggestions derived from our evaluation, we’ve got developed a one-page diagram, offered in Supplementary 2, that outlines actionable methods for advancing HTA in Iran. This diagram integrates the examine’s suggestions with examples of finest practices from established HTA businesses worldwide, such because the National Institute for Health and Care Excellence (NICE) within the United Kingdom, the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany, and the Canadian Agency for Drugs and Technologies in Health (CADTH] in Canada, the Medical Services Advisory Committee (MSAC) in Australia and the Tandvårds-Läkemedelförmånsverket (TLV) in Sweden. These world examples spotlight profitable approaches to HTA implementation, offering inspiration and sensible steerage for the Iranian context. The visible illustration goals to make clear the suggestions and their implications for policymakers, healthcare professionals, and researchers, emphasizing their potential to enhance evidence-based decision-making, useful resource allocation, and well being outcomes in Iran.