Plenary Themes

PLENARY ONE

Trust in HTA in a Time of Transformation

Across the world, confidence in public institutions, scientific expertise, and evidence-informed decision-making is being tested. Rapid technological development, changing information environments, geopolitical instability, and increasingly polarized public discourse are transforming how health systems operate and how people judge the decisions made within them. In this environment, HTA, as an institution that strives to support transparent, accountable, and evidence-informed decision-making, has the potential to build trust and legitimacy across health systems. As HTA systems evolve and collaborate across jurisdictions, including through new frameworks such as the European Union’s Health Technology Assessment Regulation, questions of trust, trustworthiness, legitimacy, and how decisions are made become increasingly important.

Trust is fundamental to the relationships that enable health systems to function and change. For HTA, this means considering not only whether assessments and recommendations are methodologically sound, but whether the processes behind them are transparent, fair, independent, responsive, and meaningful to those affected by the decisions. HTA brings together stakeholders with different perspectives and incentives, creating an opportunity for patients, citizens, clinicians, payers, policymakers, and others to build shared understanding and contribute to collective decision-making.

Trust, trustworthiness, and legitimacy are closely connected, but they are not necessarily the same. An institution may be trusted without being trustworthy, while a legitimate and trustworthy institution may not always command public confidence. Trust in an institution or recommendation may also differ from acceptance of its authority, processes, and right to make consequential decisions. The conditions that support trust and legitimacy may vary across health systems, cultures, and levels of institutional maturity. What builds confidence in one setting may not have the same effect in another, making it important to consider both shared principles and contextual differences.

The plenary will center on three core questions:

• What makes HTA processes and institutions trustworthy and legitimate?
• How can HTA build, maintain, and rebuild trust across different health-system and societal contexts?
• How can trust and legitimacy create the foundation for stronger relationships, successful implementation, and broader health-system change?

The discussion will consider where trust is being built, maintained, lost, or endangered and what this means for HTA in a changing environment. Real-world examples may include contested scientific evidence, misinformation, vaccine hesitancy, and situations in which stakeholders resist or seek to circumvent evidence-informed processes. Health-data sharing, digital transformation, and rapidly changing technologies may also provide contexts in which questions of trust and legitimacy arise. An ethics perspective can help examine conceptual and normative questions related to fairness, transparency, accountability, independence, and whose interests are reflected in HTA decision-making.

Differences between emerging and established HTA systems will provide an important perspective within this broader discussion. Challenges to trust may vary considerably across settings, whether shaped by institutional capacity, training, governance, corruption, political polarization, public expectations, or previous experiences with health and government institutions. Emerging HTA systems may offer valuable lessons about how trust and legitimacy can be established from the outset, while more established systems may have lessons to share about maintaining confidence as technologies, evidence, and societal expectations evolve.

As the opening plenary, the session will establish questions and tensions that run through the remainder of the Annual Meeting. Trust and effective relationships can create conditions for recommendations to be implemented and for stakeholders to work together on system change. Conversely, visible implementation and meaningful impact can strengthen confidence in HTA and reinforce its legitimacy. Ultimately, the plenary will examine why trust and legitimacy matter to HTA, what makes them possible, and how they can support HTA’s evolving role in health systems. By connecting conceptual questions with real-world experiences from different contexts, the session will give delegates a foundation for considering how HTA can remain trusted, trustworthy, credible, and relevant as health systems and societies transform.

PLENARY TWO

Implementation Science and HTA: Connecting Evidence to Impact

Health technology assessment invests considerable effort in evaluating evidence and informing recommendations for policy and practice. Yet even a rigorous assessment does not guarantee that a technology will be adopted, used appropriately, reach patients, or displace lower-value care. Across health systems, a persistent gap remains between what evidence supports, what decision-makers recommend, and what can actually be implemented in practice.

This gap is shaped by the conditions under which recommendations must be put into action. These include factors such as workforce capacity and training, infrastructure and diagnostic capacity, organizational readiness, funding and procurement arrangements, and the practical realities of health care delivery. Patient and caregiver needs and preferences, information dissemination, and clinical guidelines can also influence the uptake of new technologies and whether recommendations translate into meaningful change. These factors vary across health systems and technologies, and the relationship between HTA recommendations and these implementation factors is often fragmented. Together, these factors mean that implementation must be understood within the wider health system, rather than as a final step that begins only after an assessment has been completed.

Implementation science offers a useful lens for examining this challenge more systematically. By focusing on barriers, facilitators, context, adaptation, uptake, and whether changes can be sustained over time, it can help identify implementation considerations from the earliest stages of HTA, including early dialogue and evidence development, rather than only after a recommendation has been made.

This lens also offers practical approaches for anticipating and addressing barriers, strengthening the connection between assessment, recommendations, and implementation, and creating feedback loops through which experience can inform future assessments and recommendations.

Digital tools and data may also play an important role as implementation enablers. Health informatics, accessible and translatable HTA information, local and national health data, and emerging technologies such as AI could support the communication of recommendations, monitor their uptake, identify implementation gaps, and provide feedback to decision-makers and HTA organizations.

This plenary will explore three connected questions:

• How can implementation considerations be anticipated and addressed from the earliest stages of HTA?
• What gets in the way of putting HTA recommendations into practice?
• How can HTA strengthen the transition from assessment to implementation, and learn from what happens in practice?

PLENARY THREE

Beyond Technologies: HTA for Healthier Systems and Societies

Health systems and societies are being reshaped by aging populations, chronic diseases, workforce shortages, digital innovation, economic pressures, environmental threats, and geopolitical change. In response, governments and health-system leaders are being called to prioritize prevention, health promotion, and population health, recognizing that sustainable health outcomes require coordinated action both within and beyond healthcare. This calls for technologies, care pathways, workforce models, financing arrangements, and approaches to system design to work together. While some HTA organizations already incorporate elements of a broader remit, HTA mandates remain largely focused on individual technologies, creating a risk of overlooking wider system design and the longer-term implications for population health. The central question is not whether every HTA system should adopt the same broader remit, but where a wider contribution could add value, what it would require, and where its limits may lie.

Building on the Annual Meeting's exploration of trust, legitimacy, and the movement from evidence to implementation, this plenary will consider whether and how HTA's role could evolve to support healthier systems and societies. Prevention and population health provide important expressions of this broader role, but they do not define its limits. The discussion extends from individual technologies to care pathways, workforce models, integrated care, financing, and the organization of health systems; and from siloed budgetary outcomes to broader societal value experienced by patients, caregivers, citizens, governments, and society. A broader role may be valuable in some contexts and neither feasible nor appropriate in others. Such an evolution would require more than simply expanding what HTA assesses. It raises questions about the governance, evidence standards, institutional structures, financing arrangements, workforce capacity, data sources, and cross-sector relationships needed to make a broader role credible in different settings. HTA may need to consider longer-term and wider outcomes, including independence, access, caregiver burden, system resilience, social outcomes, and environmental impacts. Greater use of real-world data and digital technologies may create opportunities to understand health differently, while introducing concerns about representativeness, bias, transparency, data ownership, responsibility, and trust. Expanding the remit may open new possibilities, but it may also stretch methods, resources, authority, and institutional legitimacy.

The discussion will be guided by three connected questions:

• What can HTA organizations learn from approaches already being used today, and what could be applied now to support healthier, more equitable, and more resilient systems?
• What could HTA assess and contribute to when the goal extends beyond individual technologies toward healthier systems and societies?
• What capabilities, partnerships, evidence, financing, and institutional arrangements would be required, and in which settings would a broader role be credible and appropriate?

The plenary will explicitly test the arguments for and against a broader role. How should decision-makers balance short-term health-system costs against longer-term benefits that may extend across government departments and beyond healthcare? When do the priorities of individual patients align with, or differ from, those of citizens and society? How can HTA account for the difference between health and healthcare when many determinants of health lie outside the health system? And how can the field broaden its contribution without diluting the methodological credibility and decision-making value on which its established role is built? These trade-offs may lead different agencies and health systems to different conclusions; the session will make those choices and boundaries visible rather than imply a single model.

Drawing on tangible examples from HTA organizations and health systems already working across technologies, care pathways, and broader system-level decisions, the plenary will examine what a broader contribution can look like in practice. Examples may include value-based healthcare, innovative financing and outcomes-based contracting, social impact bonds, digital health, alternative workforce models, health-service redesign, and approaches that incorporate social and environmental outcomes. Experiences from countries with different levels of resources and institutional maturity will help distinguish principles that may transfer across settings from approaches that depend on particular local structures. Ultimately, the plenary will not prescribe one destination for every HTA system. As the closing plenary, it will connect future ambition with tangible practices and leave delegates with a clearer understanding of the options, tensions, enabling conditions, and practical actions relevant to their own settings. Its call to action is therefore not simply to expand, but to make deliberate, credible, and context-sensitive choices about how HTA can contribute to healthier, more equitable, resilient, and sustainable systems and societies.