. 2011 Aug 30;3:117–186. doi: 10.2147/CEOR.S14407

Table 2.

Comparison of processes for identifying, selecting, and assessing technologies

Country	Centralized reimbursement review/decision-making body (role)	Technologies to be considered for review		Health technology assessment
Country		Technology identification	Technology selection	Synthesis and analysis of evidence (assessment report)	Evaluation of evidence provided (evaluation report)
Austria	Association of Austrian Social Security Institutions (decisions)⁵⁵ Pharmaceutical Evaluation Board (recommendations)⁵⁶	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals⁵⁸	Typically considered in order received⁵⁸	Manufacturer through submission requirements⁵⁵ Methods should comply with internationally recognized systematic review and economic guidelines⁵⁵	Technical staff within Association of Austrian Social Security Institutions (Department of Pharmaceutical Affairs – pharmacological and medical-therapeutic assessment; Health Economics Team – economic assessment)⁵⁵
Belgium	Minister of Social Affairs (decisions) Commission on reimbursement of medicines/Drug Reimbursement Committee (CRM) (recommendations)⁹	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals¹⁷	Typically considered in order received¹⁷	Manufacturer through submission requirements⁹ Methods should comply with internationally recognized systematic review guidelines⁹	Technical staff within CRM supported by external experts⁹
Czech Republic	State Institute for Drug Control (decisions)⁶⁵	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals⁶⁶	Typically considered in order received⁶⁵	Manufacturer through submission requirements⁶⁶	Technical staff within State Institute for Drug Control⁶⁵
Denmark	Danish Medicines Agency (decisions)⁶⁸,⁶⁹,¹²¹ Reimbursement Committee (recommendations)⁶⁸,¹²¹	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals⁸⁴	Typically considered in order received⁸⁴	Manufacturer through submission requirements⁶⁸ Methods must comply with “Danish guidelines for the socioeconomic analysis of medicines”⁶⁸	Technical staff within Danish Medicines Agency supported by external experts, if necessary⁶⁸
Estonia	Ministry of Social Affairs (decisions)⁷² Pharmaceuticals Committee (recommendations)⁷²	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals⁷²	Not specified	Manufacturer through submission requirements⁷²	Technical staff within Estonian Health Insurance Fund and State Agency of Medicines⁷²
Finland	Pharmaceuticals Pricing Board (decisions)⁷³,⁷⁴,⁷⁶ Pharmaceuticals Pricing Board Expert Group (recommendations)⁷⁵	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals⁷⁶	Typically considered in order received⁷³	Manufacturer through submission requirements¹²² Methods must comply with guidelines of the Ministry of Social Affairs and Health¹²²	Technical staff within Pharmaceuticals Pricing Board supported by external experts¹²²
France	Ministry for Health and Social Security (decisions)²¹,⁷⁸ French National Authority for Health (recommendations)⁷⁸	Depends on type of appraisal1⁶,²⁰ Single technology appraisal Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals and devices Health care professional associations seeking reimbursement for procedures Multiple technology appraisals Typically classes of pharmaceuticals or categories of devices Referred by: Health care professional associations Ministry of Health National Union of Health Insurance Funds Patient and/or carer organizations¹²⁰	Single technology appraisals Typically considered in order received¹⁶ Multiple technology appraisals Selection criteria not specified	Single technology appraisals Manufacturer through submission requirements²⁰ Multiple technology appraisals Technical staff within Health and Social Security supported by external experts²⁰ Methods should comply with internationally recognized systematic review and economic guidelines²⁰	Single technology appraisals Technical staff within Health and Social Security supported by external experts²⁰ Multiple technology appraisals Technical staff within Health and Social Security or independent academic group²⁰
Germany	Federal Joint Committee (decisions)¹⁹ Institute for Quality and Efficiency in Health Care (recommendations)¹⁹	Referred by: Associations represented by Federal Joint Committee Ministry of Health Institute for Quality and Efficiency in Health Care Federal commissioner of patient affairs Patient and/or carer organizations¹⁸	Determined by Federal Joint Committee Selection criteria: Clinical relevance Cost implications “Risks”⁶	Technical staff within Institute for Quality and Efficiency in Health Care supported by external experts¹²³,¹²⁴ Methods must comply with Institute for Quality and Efficiency in Health Care systematic review and economic guidelines¹²⁴	Technical staff within Institute for Quality and Efficiency in Health Care supported by external experts¹²³,¹²⁴
Greece	Transparency Committee in the Reimbursement and Medicinal Products (makes decisions)⁸⁵	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals⁸⁵	Not specified	Manufacturer through submission requirements⁸⁵	Technical staff within Transparency Committee in the Reimbursement and Medicinal Products⁸⁵
Hungary	Ministers of Health and Finance (decisions) National Health Insurance Fund Administration (recommendations)⁸⁸,⁸⁹	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals National Health Insurance Fund Administration⁸⁸	Not specified	Technical staff within National Technology Assessment Office of the National Institute for Strategic Health Research⁹⁰	Technical staff within National Technology Assessment Office of the National Institute for Strategic Health Research⁹⁰
Ireland	Health Service Executive (decisions)⁹¹,⁹²	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals⁹¹ Referred by: Department of Health and Children of the Health Services Executive for new and existing devices and diagnostic tests that might “incur a high cost or have a significant budget impact”⁹¹	Not specified	Manufacturer through submission requirements⁹³,¹²⁵ Methods must comply with Irish Health Technology Assessment Guidelines⁹³	Technical staff within National Centre for Pharmacoeconomics, supported by external clinical experts⁹³
Italy	Italian Medicines Agency Technical Scientific Committee (decisions)⁹⁴ Italian Medicines Agency Pricing and Reimbursement Committee (recommendations)⁹⁵	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals²⁷	Typically considered in order received²⁷	Manufacturer through submission requirements¹²⁶ Methods must comply with Italian submission guidelines²⁷	Members of Technical Scientific Committee¹²⁶
Norway	Norwegian Medicines Agency (decisions)⁹⁸ Department of Pharmacoeconomics (recommendations)⁹⁸	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals³⁴	Not specified	Manufacturer through submission requirements³⁴ Methods should comply with internationally recognized systematic review guidelines³⁴	Technical staff within Norwegian Medicines Agency and Department of Pharmacoeconomics⁹⁸
Poland	Ministry of Health (decisions)⁹⁹	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals⁹⁹	Not specified	Manufacturer through submission requirements⁹⁹	Technical staff within Ministry of Health⁹⁹ Agency for Health Technology Assessment¹²⁷
Portugal	Ministry of Health (decisions) INFARMED (recommendations)³⁶,⁴⁵	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals³⁶	Not specified	Manufacturer through submission requirements³⁶	Technical staff within INFARMED supported by external experts³⁶
Scotland	National Health Service Scotland (decisions)³⁰ Scottish Medicines Consortium (recommendations)	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals¹⁰⁴ Automatic within 12 weeks of market launch¹⁰⁴	Exclusion criteria: Already appraised by National Institute of Health and Clinical Excellence through its multiple technologies appraisal process¹⁰⁴	Manufacturer through submission requirements¹²⁸ Methods must comply with Scottish Medicines Consortium systematic review and economic guidelines³⁴	Technical staff within Scottish Medicines Consortium supported by external experts¹²⁸
Slovakia	Ministry of Health (decisions) Reimbursement Committee for Medicinal Products (recommendations)¹⁰⁵,¹⁰⁷,¹²⁹,¹⁰⁶	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals¹⁰⁴	Not specified	Manufacturer through submission requirements¹³¹	Working group for pharmacoeconomics and outcomes research¹³¹
Spain	Ministry of Health Directorate General of Pharmacy and Health Products Inter-Ministerial Pricing Commission (decisions)²¹,¹⁰⁸	Referred by: Ministry of Health (newly approved pharmaceuticals)¹⁰⁸	Not specified	Manufacturer through invitation to submit information to Inter-Ministerial Pricing Commission²¹ Technical staff within Ministry of Health¹³²	Inter-Ministerial Pricing Commission²¹
Sweden	Dental and Pharmaceutical Benefits Board (decisions)¹⁵,¹⁰⁹,¹¹⁰	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals¹⁰⁴ Dental and Pharmaceutical Benefits Board (for pharmaceuticals approved prior to 2002)¹³³,¹³⁴	For new pharmaceuticals: typically considered in order received For older pharmaceuticals: Overall sales volume¹³⁴,¹³⁵	For new pharmaceuticals: Manufacturer through submission requirements¹³⁶ For older pharmaceuticals: Technical staff within Dental and Pharmaceutical Benefits Board supported by external experts¹³⁶ Methods must comply with Dental and Pharmaceutical Benefits Board systematic review and economic guidelines¹⁰	For new pharmaceuticals: Technical staff within Dental and Pharmaceutical Benefits Board¹³⁶ For older pharmaceuticals: Technical staff within Dental and Pharmaceutical Benefits Board supported by external experts¹³⁶
Switzerland	Swiss Federal Office of Public Health (decisions) Federal Drug Commission (recommendations)¹¹⁴,¹¹⁵	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals¹¹⁴ Patients and carers Hospitals and hospital groups Health care professional associations Federal Office of Public Health¹¹⁴,¹³⁷	Not specified	Manufacturer through submission requirements¹¹³	Federal Drug Commission¹¹⁴
The Netherlands	Ministry of Health, Welfare and Sport (decisions) Medicinal Products Reimbursement Committee of the Dutch Healthcare Insurance Board (recommendations)¹¹⁶	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals³¹ University hospital federations, health care professional associations, and Dutch Healthcare Insurance Board for high-cost inpatient pharmaceuticals	Not specified	Manufacturer through submission requirements³¹ Technical staff within Dutch Healthcare Insurance Board¹¹⁷ Methods must comply with internationally recognize systematic review guidelines and Dutch Healthcare Insurance Board economic guidelines¹¹⁷	Technical staff within Dutch Healthcare Insurance Board¹¹⁷
United Kingdom	National Institute for Health and Clinical Excellence (decisions) Technology Appraisals Committee (recommendations)⁷	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals Patients and carers Health care providers Health care professional associations General Public National Horizon Scanning Centre¹²⁰	Selection criteria: Burden of disease (population affected, mortality, and morbidity) Resource impact (on National Health Service costs and resources) Clinical importance Policy importance (alignment with government priority areas) Inappropriate variations in practice Likelihood of national guidance adding value⁷ Technology selection panel composition: Health care providers (specialists, general practitioners, and public health professionals) Patient representatives Technology selection panel makes recommendations. Final decisions made by Department of Health⁷	Single technology appraisals Manufacturer through submission requirements¹²⁰ Multiple technology appraisals Independent academic group¹²⁰ Methods must comply with National Institute for Health and Clinical Excellence systematic review and economic guidelines¹²⁰	Single technology appraisals Independent academic group¹²⁰ Multiple technology appraisals Independent academic group¹²⁰
Wales	Ministry for Health and Social Services (decisions) All Wales Medicines Strategy Group (recommendations)²⁸	Referred by: Manufacturers seeking reimbursement for newly approved pharmaceuticals²⁸ Welsh Medicines Partnership horizon scanning process for identifying pharmaceuticals expected to receive market approval within 18 months²⁸	Typically considered in order received²⁸	Manufacturer through submission requirements²⁸ Welsh Medicines Partnership²⁸ Methods must comply with All Wales Medicines Strategy Group systematic review and economic guidelines²⁸	Welsh Medicines Partnership²⁸