Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
  Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login  
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 3906       

   Table of Contents      
Year : 2020  |  Volume : 152  |  Issue : 5  |  Page : 444-447

Health technology assessment in India: Reflection & future roadmap

1 Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
2 Department of Health Research, Ministry of Health & Family Welfare, Government of India, New Delhi 110 001, India
3 Department of Health Research, Ministry of Health & Family Welfare, Government of India, New Delhi 110 001; Formerly Senior Deputy Director General, Indian Council of Medical Research, New Delhi 110 029, India

Date of Submission22-Jan-2019
Date of Web Publication8-Mar-2021

Correspondence Address:
Shankar Prinja
Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmr.IJMR_115_19

Rights and Permissions

How to cite this article:
Prinja S, Rajsekhar K, Gauba VK. Health technology assessment in India: Reflection & future roadmap. Indian J Med Res 2020;152:444-7

How to cite this URL:
Prinja S, Rajsekhar K, Gauba VK. Health technology assessment in India: Reflection & future roadmap. Indian J Med Res [serial online] 2020 [cited 2021 Jul 27];152:444-7. Available from:

One of the aspirational goals of the Government of India is to achieve Universal Health Coverage[1]. Considering the increasing disease burden and underfunded health system, it appears challenging for the government to meet all the health needs of the population[2]. Therefore, optimum allocation and utilization of the available resources is quintessential. Health technology assessment (HTA) is a promising and a globally accepted tool to facilitate evidence-based priority setting for efficient and equitable resource allocation[3],[4]. HTA is a multidisciplinary process to systematically evaluate the clinical, social, economic, organizational, and ethical issues of a health intervention or technology, so that the intervention offering maximum health gains from limited or scarce resources can be selected[3].

Marking an important development in the government's commitment towards a transparent, evidence-informed practice (EIP) for resource allocation, HTA was recommended under several government policies, such as the Twelfth Five Year Plan[5] (2012-2017) and National Health Policy[6](2017). This was followed by creation of Health Technology Assessment in India (HTAIn) – an institutional structure created in the Department of Health Research (DHR), Ministry of Health and Family Welfare (MoHFW), New Delhi, India[7],[8],[9]. The strategic position of DHR in terms of functional linkage to MoHFW as well as National Institute for Transforming India (NITI) Aayog – the strategic policymaking arm of Central Government, and several other regulatory bodies implies that all factors leading research towards policymaking are favourably aligned. This paper attempts to outline the major HTA based initiatives undertaken so far, and the steps for the future. These are discussed in the following three domains – capacity building, supporting HTA research, ensuring the transfer of bench-level research to policy.

The first challenge was to identify and build a community of credible HTA researchers. The HTAIn Secretariat at the DHR undertook several steps in this direction, in partnership with the International Decision Support Initiative (iDSI) and Regional Resource Hub at Postgraduate Institute of Medical Education and Research, Chandigarh, India. A series of capacity-building workshops were initiated to train the participants from technical partners (government, semi-government and private) in various aspects of undertaking an HTA[8].

For the identification of technical partners and availability of expertise therein, an HTA capacity assessment questionnaire was circulated by HTAIn among several Indian academic and research institutes in 2015[9]. This lead to selection of technical partners and identification of areas requiring further capacity building. The gap-analysis revealed deficiency in two key areas – economic evaluation and decision modelling. Another domain included in the questionnaire was systematic reviews and meta-analysis, which is also a recommended strategy for effectiveness assessment. Therefore, the focus areas for capacity building were centred primarily on these aspects. The Secretariat also created regional resource hubs to develop local capacity and expertise to support State-specific needs in these regions[10]. Alongside, the DHR created a fellowship programme to train its scientists in the field of HTA in eminent universities.

The second step was to develop the data and systems to facilitate effective conducting of economic evaluation, which is an important tool of HTA[11],[12],[13]. Two data gaps for conducting of economic evaluations included – data on cost of health-care services and determining Indian quality of life (QOL) tariff values for health states. Being an essential requirement for HTA studies, most countries with an established HTA system have created database to record such information. In line with the National Institute for Health and Care Excellence (NICE), United Kingdom, and Health Intervention and Technology Assessment Program (HITAP), Thailand, HTAIn has made efforts in creating such databases. A nationally representative study to estimate the cost of various services and procedures, in both public and private sector, is presently underway in 13 Indian States[14]. This study will help generate unit cost of healthcare services and procedures at both secondary and tertiary care hospitals which will further build on the evidence from previous studies[15],[16],[17]. A cost database has been created, which can be used for planning healthcare services, determining provider payment rates, and conducting HTA[18].

Measuring quality of life (QOL) to incorporate utility values is an integral part of an economic evaluation[19]. As QOL is a context-specific concept, it is imperative for a country to have its indigenous QOL value set[20]. Therefore, another large nationally representative study to determine the Indian value set using EQ-5D-5L health states was commissioned[21]. This study will not only generate an Indian value-set, but also answer several methodological questions around the valuation of health consequences in HTA studies[21].

Increasing number of HTA studies in the country necessitates a systematic management and provision of HTA-related information. Therefore, in line with the National Institute for Health Research (NIHR) HTA database[22], HTAIn is in the process of establishing a database of studies which it has itself commissioned[7]. Other innovations for knowledge synthesis include suggestions for the introduction of a national HTA journal, establishment of primary HTA data repositories and creation of a national repository of decision models, which will not only serve as valuable resources for locating literature and information but also reduce unintended duplication of effort by researchers.

Besides developing robust data systems for HTA studies, conducting of the analysis also needs to be standardized. Heterogeneity in methods for economic evaluations undertaken in India has been previously reported in a systematic review[13]. Therefore, standardization of the HTA methods is needed, so that evidence across studies can be compared at face value. A reference case for undertaking HTA in India has been developed along with an HTA manual which details all the steps and processes to be followed for an HTA study[10].

To make an HTA study comprehensive, it will be useful to incorporate aspects of evaluation, beyond efficiency, viz effects on equity, out-of-pocket expenditure and financial risk protection. These aspects would be relevant to align the HTA based decisions with the broad objectives of the universal health coverage policies.

The third aspect for the future of HTA research involves enhancing its uptake for policy making. The HTAIn Secretariat has established liaison with the MoHFW, NITI Aayog, National Health Systems Resource Centre, National Health Authority, National Pharmaceutical Pricing Authority, Central Drug Standards Control Organization, and various other State level departments of health. This will promote the uptake of HTA research for the policy making, as these organizations play a key role in health policy decisions. For example, a recent DHR study informed consultations which led to pricing of health benefit packages under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)[23].

Second, while several current evaluations by the HTAIn relate to medical devices, public health programmes as well as platforms of care[10], it will be important to expand the frontiers in value-based pricing and pharmacoeconomics[24]. Since a lot of the drug procurement in India happens at the State level through drug procurement corporations[25], it is important for Regional Resource Hubs and HTAIn Secretariat to foster a partnership with these agencies.

Another critical area being spearheaded by the Secretariat includes the development of standard treatment guidelines (STGs). While previous attempts at developing STGs have limited themselves to evidence around clinical effectiveness[26], it will be pertinent to include evidence on cost-effectiveness as well.

Finally, apart from evaluating newer interventions for introduction in the health system, HTA can also be used to assess the cost-effectiveness of technologies which are already operational. For instance, for population-based cervical cancer screening of women, National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) recommends the screening strategy of visual inspection with acetic acid (VIA) at a frequency of five years[27]. This intervention has now been evaluated in a study commissioned by HTAIn, which considered all the available screening alternatives, and concludes that VIA every five years is the most cost-effective option in India[28]. Hence, HTA can be used as a potential tool to gauge the impact of such policy decisions.

The final aspect to address for the future will be how decisions on priority setting are taken[29],[30]. To facilitate this process, it is crucial to ensure greater stakeholder participation, better dissemination of evidence, and transparent management of conflicts of interest. The decision regarding cost-effectiveness of an intervention is made by comparing its health benefits against a threshold. The future of HTAIn calls for developing objective methods and explicit value systems to enable the policymakers in defining a threshold for making decisions.

The HTAIn has also designed a 'Process Manual for HTA', which contains methodological guidelines for conducting of HTA studies in India. The Secretariat should also ensure that there is the institutionalization of the processes, adherence to quality standards and retention of a skilled workforce. Appropriate incentives for capacity building as well as retention of the skilled workforce will be crucial to create a critical mass of HTA researchers, so that the pace of this important journey is not slowed down.

Lessons from countries where HTA has been a success, suggest that factors such as the high proportion of public investment and strategic purchasing, political will and legislation, good health information infrastructure, local training on HTA related disciplines, effective collaboration among stakeholders and a country's independence from external aid have proven to be conducive for the institutionalization of HTA[31],[32]. India should take due care to address pertinent challenges in the way of institutionalizing HTA.

Besides these, several challenges of political economy like perception of HTA being a barrier to innovations and a tool to ration healthcare to contain costs also needs to be addressed[33]. Thus, HTAIn would need to engage with all stakeholders which also ensures that innovations and development and making evidence-informed choices do not become adversaries.

The journey of HTAIn has so far enjoyed the support of the political leadership, policymakers as well as the researcher community. However, impact assessment in terms of cost savings for the health system, gain in health outcomes, improvement in distributional effects across population sub-groups and higher financial risk protection will be paramount for the future advocacy for HTAIn.

Conflicts of Interest: None.

   References Top

Patel V, Parikh R, Nandraj S, Balasubramaniam P, Narayan K, Paul VK, et al. Assuring health coverage for all in India. Lancet 2015; 386 : 2422-35.  Back to cited text no. 1
World Health Organisation. Out-of-pocket health expenditure (% of private expenditure on health). World Health Organization Global Health Expenditure Database. Geneva:WHO, 2016.  Back to cited text no. 2
World Health Organization. Health technology assessment. Available from:, accessed on May 16, 2019.  Back to cited text no. 3
Chalkidou K, Glassman A, Marten R, Vega J, Teerawattananon Y, Tritasavit N, et al. Priority-setting for achieving universal health coverage. Bull World Health Organ 2016; 94 : 462-7.  Back to cited text no. 4
Planning Commission, Government of India. Twelfth Five Year Plan (2012–2017). Social sectors, volume III; 2017. Available from:, accessed on February 22, 2021.   Back to cited text no. 5
Ministry of Health and Family Welfare, Government of India. National Health Policy 2017. New Delhi: MoHFW, Government of India; 2017.  Back to cited text no. 6
Jain S, Rajshekar K, Sohail A, Gauba VK. Department of health research-health technology assessment (DHR-HTA) database: National prospective register of studies under HTAIn. Indian J Med Res 2018; 148 : 258-61.  Back to cited text no. 7
Prinja S, Downey LE, Gauba VK, Swaminathan S. Health technology assessment for policy making in India: Current scenario and way forward. Pharmacoecon Open 2018; 2 : 1-3.  Back to cited text no. 8
Downey LE, Mehndiratta A, Grover A, Gauba V, Sheikh K, Prinja S, et al. Institutionalising health technology assessment: Establishing the medical technology assessment board in India. BMJ Glob Health 2017; 2 : e000259.  Back to cited text no. 9
Department of Health Research. Health Technology Assessment in India - HTAIn. Available from:, accessed on August 29, 2018.  Back to cited text no. 10
Downey L, Rao N, Guinness L, Asaria M, Prinja S, Sinha A, et al. Identification of publicly available data sources to inform the conduct of Health Technology Assessment in India. F1000Res 2018; 7 : 245.  Back to cited text no. 11
Drummond M, Sculpher M, Claxton K, Stoddart G, Torrance G. Methods for the economic evaluation of health care programmes. 4th ed. New York: Oxford University Press; 2015.  Back to cited text no. 12
Prinja S, Chauhan AS, Angell B, Gupta I, Jan S. A systematic review of the state of economic evaluation for health care in India. Appl Health Econ Health Policy 2015; 13 : 595-613.  Back to cited text no. 13
Prinja S, Singh MP, Guinness L, Rajsekar K, Bhargava B. Establishing reference costs for the health benefit packages under universal health coverage in India: Cost of health services in India (CHSI) protocol. BMJ Open 2020; 10 : e035170.   Back to cited text no. 14
Prinja S, Jeet G, Verma R, Kumar D, Bahuguna P, Kaur M, et al. Economic analysis of delivering primary health care services through community health workers in 3 North Indian states. PLoS One 2014; 9 : e91781.  Back to cited text no. 15
Prinja S, Gupta A, Verma R, Bahuguna P, Kumar D, Kaur M, et al. Cost of delivering health care services in public sector primary and community health centres in North India. PLoS One 2016; 11 : e0160986.  Back to cited text no. 16
Prinja S, Balasubramanian D, Jeet G, Verma R, Kumar D, Bahuguna P, et al. Cost of delivering secondary-level health care services through public sector district hospitals in India. Indian J Med Res 2017; 146 : 354-61.  Back to cited text no. 17
Prinja S, Chauhan AS, Rajsekhar K, Downey L, Bahuguna P, Sachin O, et al. Addressing the cost data gap for universal healthcare coverage in India: A call to action. Value Health Reg Issues 2020; 21 : 226-9.  Back to cited text no. 18
Auld MC, Donaldson C, Mitton C, Shackley P. Health economics and public health. In: Oxford textbook of public health. 2nd ed. Oxford: Oxford University Press; 2002. p. 888.  Back to cited text no. 19
The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med 1995; 41 : 1403-9.  Back to cited text no. 20
Jyani G, Prinja S, Kar SS, Trivedi M, Patro B, Purba F, et al. Valuing health-related quality of life among the Indian population: A protocol for the Development of an EQ-5D Value set for India using an Extended design (DEVINE) study. BMJ Open 2020; 10 : e039517.  Back to cited text no. 21
NIHR-HTA Database INAHTA. HTA Tools & Resources. Available from:, accessed on May 16, 2019.  Back to cited text no. 22
Prinja S, Singh MP, Rajsekar K, Sachin O, Gedam P, Nagar A, et al. Translating Research to Policy: Setting provider payment rates for strategic purchasing under India's national publicly financed health insurance scheme. A ppl Health Econ Health Policy 2021. doi: 10.1007/s40258-020-00631-3.  Back to cited text no. 23
Selvaraj S, Farooqui HH, Karan A. Quantifying the financial burden of households' out-of-pocket payments on medicines in India: A repeated cross-sectional analysis of National Sample Survey data, 1994-2014. BMJ Open 2018; 8 : e018020.  Back to cited text no. 24
Prinja S, Bahuguna P, Tripathy JP, Kumar R. Availability of medicines in public sector health facilities of two North Indian States. BMC Pharmacol Toxicol 2015; 16 : 43.  Back to cited text no. 25
National Health Mission. Standard treatment guidelines. Available from:, accessed on October 22, 2018.  Back to cited text no. 26
Ministry of Health and Family Welfare, Government of India. Operational Guidelines: National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). Available from:, accessed on May 19, 2020.  Back to cited text no. 27
Chauhan AS, Prinja S, Srinivasan R, Rai B, Malliga JS, Jyani G, et al. Cost effectiveness of strategies for cervical cancer prevention in India. PLoS One 2020; 15 : e0238291.   Back to cited text no. 28
Kieslich K, Bump JB, Norheim OF, Tantivess S, Littlejohns P. Accounting for technical, ethical, and political factors in priority setting. Health Syst Reform 2016; 2 : 51-60.  Back to cited text no. 29
Bobadilla JL, Cowley P, Musgrove P, Saxenian H. Design, content and financing of an essential national package of health services. Bull World Health Organ 1994; 72 : 653-62.  Back to cited text no. 30
Chootipongchaivat S, Tritasavit N, Luz A, Teerawattananon Y, Tantivess S. Conducive factors to the development of health technology assessment in Asia . F1000Res 2017; 6 : 486.  Back to cited text no. 31
Mohara A, Youngkong S, Velasco RP, Werayingyong P, Pachanee K, Prakongsai P, et al. Using health technology assessment for informing coverage decisions in Thailand. J Comp Eff Res 2012; 1 : 137-46.  Back to cited text no. 32
Luce B, Cohen RS. Health technology assessment in the United States. Int J Technol Assess Health Care 2009; 25 (Suppl 1) : 33-41.  Back to cited text no. 33


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article

 Article Access Statistics
    PDF Downloaded308    
    Comments [Add]    

Recommend this journal