The state of the art of HTA in mature contexts: the Canadian experience

The process of Health Technology Assessment (HTA) involves evaluating the value of health technologies. The suitable implementation of HTA is contingent on the particular context in which the assessment is conducted, taking into account the stakeholders, stages of the process, techniques, and criteria used for evaluation. While the significance of HTA is widely acknowledged, more literature is required to analyse better the HTA process, particularly investigating how its principal elements diverge in diverse settings. To bridge this gap, a systematic network analysis of literature was carried out to determine the most investigated Canadian HTA research streams. Canada, ranked in the top ten globally for its public healthcare system and boasting a wealth of health technology innovations, serves as a mature context where the HTA approach is consistently and effectively utilized across healthcare organizations at all levels. Seven streams were identified, including macro-HTA, meso-HTA, micro-HTA, ethical considerations, and patient involvement. The manuscript brings into the spotlight the fundamental components of the HTA process involved in each of these streams. The network analysis also uncovers various literature gaps. Future research should investigate how to include qualitative and quantitative aspects in HTA and overcome obstacles associated with patients' involvement. This paper provides theoretical and practical contributions by illuminating the organisational structure of the HTA approach and delivering guidance to practitioners in seeking more effective implementations of HTA.