To the Editor-in-Chief, International Journal of Technology Assessment in Health Care, Cambridge University Press.

We thank the author for the response and the clarifications provided regarding the Slovenian health technology assessment (HTA) and pricing and reimbursement (P&R) system. We also acknowledge the recognition that reimbursement decision making in Slovenia incorporates structured assessment elements, including clinical effectiveness, cost-effectiveness, budget impact, and other nonclinical or ethical considerations.

We would like to clarify the intent of our original formulation. The term “underdeveloped” was not intended to suggest the absence of relevant HTA principles, nor to overlook the functioning of the existing, highly pragmatic P&R framework. Rather, it referred specifically to the absence of a formally designated and institutionally independent HTA body within the evolving European context, particularly in light of Regulation (EU) 2021/2282.

We also appreciate the author’s perspective that increased institutionalization does not automatically translate into improved outcomes, and that system efficiency, pragmatism, and timely access are essential considerations. We agree that these aspects must be carefully preserved and considered in any future development of HTA structures, alongside alignment with EU requirements.

Within the framework of the EU HTA Regulation, which introduces Joint Clinical Assessments at the European level while maintaining national responsibility for appraisal and reimbursement, further development of national HTA capacity may nevertheless be considered. In this context, a more clearly defined and independent HTA function could optimally support the use of joint clinical evidence alongside national assessments of nonclinical dimensions. Furthermore, it may contribute to greater transparency by distinctly separating evidence appraisal from subsequent decision making under budgetary constraints.

Such an approach could be understood as integration with existing processes, with an HTA function focusing on structured assessment of comparative value. At the same time, the payer retains responsibility for pricing and budgetary decisions. This may help ensure close coordination between evidence generation and decision-making while avoiding unnecessary duplication of effort.

Sincerely,

Katarina Beravs Bervar, Wim Goetsch, Inaki Gutierrez Ibarluzea, Adam Skali, Iga Lipska, Alric Rüther, and Eva Turk.