Developing, Implementing, Disseminating, and Sustaining Health Economic Evaluation Guidelines - A Scoping Review of International Examples, Process Facilitators, and Barriers

Background/Objectives: Health economic evaluations (HEEs) play only a minor role in Austrian reimbursement decisions. Austria has no binding health economic evaluation guideline (HEEG) with a defined reference case or standardised requirements for economic evidence. The establishment of the appraisal board for selected medicines in 2023 has increased the need for a nationally consistent approach.

Methods: This report is based on a scoping review of published literature on HEEG development and implementation, complemented by expert knowledge. An exploratory hand search in Google Scholar and PubMed identified publications describing the development, implementation, dissemination, and sustainment (DIDS) process. Information on the four DIDS dimensions was extracted across standardised categories, process steps were compared across countries and grouped into common phases, and barriers and facilitators were grouped inductively. Findings for Austria were interpreted across six aspects, including objectives, stakeholder engagement, and institutional arrangements.

Results: Nine publications covering five countries (Canada, South Korea, Japan, China, and Lebanon) plus a systematic review of low- and middle-income country experiences were included. Despite considerable variation, a common eight-phase DIDS process emerged, from policy need identification to dissemination and sustainment. Governance clarity and a legal basis were critical for sustainment, while expertise shortages and data limitations were universal barriers. Stakeholder engagement was the most consistent facilitator. Sustainment was the least systematically documented phase.

Discussion: Austria's greatest opportunities lie in establishing a mandatory HEEG beyond the appraisal board, investing in local data and capacity, and anchoring institutional responsibility in a dedicated HTA unit. Regardless of the institutional model chosen, separating technical evidence generation from political decision-making, while maintaining integration into existing decision-making structures, appears essential for long-term success.

Conclusion: International experience offers a clear roadmap for Austria. A successful DIDS process depends on a clear political mandate, dedicated institutional responsibility, and explicit planning for dissemination and sustainment from the outset.