I read with great interest the recent article by Zorzetto et al., “A hospital-based HTA model to assess the economic and organizational impact of intravenous-to-subcutaneous monoclonal antibody transitions in oncology.” (Int J Technol Assess Health Care. 2026;42(1):e79. doi:10.1017/S0266462326104000). The authors provide an instructive example of hospital-based health technology assessment (HB-HTA), integrating local data on drug acquisition, pharmacy preparation, nursing time, chair occupancy, and treatment capacity. Importantly, they demonstrate that the organizational value of subcutaneous administration is context-dependent: released capacity generates tangible value where latent demand exists, whereas in less capacity-constrained settings the same efficiency gains may primarily provide greater organizational flexibility (Reference Zorzetto, Russi and Giuriola1).

Their study raises a broader question: what should actually be assessed at hospital level? Rather than conceptualizing HB-HTA simply as HTA conducted on a smaller scale, its distinctive value may lie in assessing those dimensions that centralized HTA cannot adequately capture.

The case presented by Zorzetto et al. illustrates this distinction particularly well. Evidence on the comparative clinical efficacy and safety of intravenous and subcutaneous formulations is largely transferable across institutions. In contrast, pharmacy workload, nursing time, chair occupancy, patient volumes, capacity constraints, and opportunities for resource redeployment are inherently local. Released chair time, for example, has no universal economic value; its consequences depend on whether additional patients are waiting for treatment and whether released resources can be redeployed (Reference Zorzetto, Russi and Giuriola1).

This distinction is important because HB-HTA itself requires scarce analytical resources. An international expert-panel study identified limited human resources as a major barrier to HB-HTA, while networking, methodological support, training, and collaboration were important facilitators (Reference Lipska, Di Bidino and Niewada2). The authors consequently emphasized the need to balance methodological depth and complexity against workload and timeliness (Reference Lipska, Di Bidino and Niewada2). These challenges are not confined to European settings. A recent qualitative study in Iran similarly identified shortages of trained personnel, heavy workloads, inadequate information infrastructure, fragmented decision making, and weak stakeholder collaboration as barriers to implementation (Reference Behzadifar, Talebzadeh and Aalipour3). Particularly revealing is the coexistence of limited hospital-level capacity with centralized governance that can restrict local adaptation and delay implementation (Reference Behzadifar, Talebzadeh and Aalipour3).

Taken together, these findings suggest a pragmatic division of labor. Evidence that is transferable across settings should, where possible, be generated or synthesized centrally, while hospitals concentrate their limited analytical resources on questions for which local context may influence the decision. This does not diminish HB-HTA; rather, it defines more clearly where it adds value.

As HTA becomes increasingly coordinated at national and European levels, the objective should perhaps not be more HB-HTA, but more focused HB-HTA: reuse what is transferable and assess locally what is context-dependent.