Introduction
Jordan has a diverse healthcare system that integrates both public and private sectors, delivering primary, secondary, and tertiary care with broad access to essential and preventive care (1;2). As a lower-middle-income country, Jordan reported a gross domestic product (GDP) of 31.90 billion Jordanian dinars (JOD) (USD 44.99 billion) in 2024, with a GDP per capita of JOD 3123.14 (USD 4405). Approximately, 8 percent of the GDP is spent on healthcare in Jordan – a relatively high proportion compared to other countries with similar economic profiles (2). However, the Jordanian healthcare system currently faces mounting challenges due to rapid population growth, including successive refugee influxes, an epidemiological shift toward chronic diseases, and increasing healthcare costs. These challenges underscore the need for effective tools and strategies to optimize resource allocation (1).
Health technology assessment (HTA) is a multidisciplinary approach that evaluates the clinical data and cost-effectiveness of health technologies within broader policy and societal contexts (Reference Hammad3;Reference O’Rourke, Oortwijn, Schuller and Group4). It serves as a systematic and comprehensive tool that integrates medical, ethical, and economic evidence to inform decision-making (Reference Alzarea, Khan and Alanazi5). Effective HTA implementation requires robust research infrastructure, data availability, and technical expertise (Reference Alzarea, Khan and Alanazi5). In Jordan, HTA activities are currently conducted at limited institutional levels, such as the King Hussein Cancer Center and the Royal Medical Services, without a centralized national framework or formal HTA agency. Instead, HTA-related functions are partially addressed through advisory committees, which lack a unified structure, formal mandate, and standardized processes for evidence-informed decision-making (Reference Hammad3). Although HTA is increasingly being adopted globally, its implementation in low- and middle-income countries (LMICs) is often constrained by insufficient financial and human resources, fragmented healthcare systems, and limited awareness of HTA principles among decision-makers (Reference Fasseeh, Karam and Jameleddine6;Reference Al Rabayah, Al Froukh and Sawalha7). In Jordan, a previous study exploring the strategic development and institutionalization of HTA revealed additional challenges, including the absence of formal legislation or regulatory frameworks mandating HTA use (Reference Almomani, Alabbadi and Fasseeh8), a shortage of trained multidisciplinary experts (Reference Fasseeh, Karam and Jameleddine6;Reference Almomani, Alabbadi and Fasseeh8), overreliance on international data that may not fully reflect local epidemiological and economic contexts (Reference Fasseeh, Karam and Jameleddine6;Reference Almomani, Alabbadi and Fasseeh8), and potential dependence on private-sector funding, which may restrict the independence of HTA activities (Reference Fasseeh, Karam and Jameleddine6). Although prior work provides valuable strategic directions for HTA development in Jordan, empirical evidence on practical barriers and facilitators remains limited, particularly from the perspectives of researchers and decision-makers (Reference Fasseeh, Karam and Jameleddine6).
Understanding these factors is critical for strengthening HTA integration into policy and practice. This study aimed to assess the barriers and facilitators influencing both the conduct of HTA by researchers and the implementation of its findings by decision-makers in Jordan and to identify context-specific priorities to enhance evidence-informed decision-making. Conducting HTA refers to the generation of economic evaluations and evidence (e.g., methodological capacity, data availability, and expertise), whereas implementing HTA refers to its integration into policy, reimbursement, and regulatory processes (e.g., governance structures, political commitment, and institutional mandates) (Reference Behzadifar, Ghanbari and Azari9).
Methods
Study design and population
This was a cross-sectional study conducted in Jordan between 1 June and 29 July 2024, using an online self-administered questionnaire and purposive sampling. Participants included researchers and decision-makers in the healthcare sector. Researchers were defined as individuals with at least one publication in HTA/economic evaluation, involvement in pharmacoeconomic research, an academic affiliation related to health economics in Jordan, or a contribution to local or international health economics, pharmacoeconomics, or HTA conferences within the past 2 years. Decision-makers included professionals actively involved in applying pharmacoeconomics or HTA in practice, working in public, private, or teaching hospitals. Additionally, professionals working within administrative committees related to drug pricing (e.g., Ministry of Health [MOH], Joint Procurement Department [JPD]) and those who had received training in pharmacoeconomics or HTA were also included in the study. Participants were classified as “researchers” or “decision-makers” based on their self-identified primary role, with individuals holding dual roles categorized according to their primary HTA-related function (evidence generation or policy/decision-making).
Sampling and data collection
Eligible participants were identified through purposive sampling by systematically applying the predefined inclusion criteria to identify researchers and decision-makers engaged in HTA- and pharmacoeconomics-related activities in Jordan. This mapping included individuals from academia, public sector institutions (e.g., MOH and JPD), hospitals, regulatory and reimbursement-related committees, and the pharmaceutical industry. Potential participants’ contact information was obtained from professional databases (PubMed, Google Scholar, LinkedIn, and ResearchGate), and institutional websites. Given the absence of a clearly defined national pool of experts in this field, the identified list was supplemented using a snowball approach to expand recruitment. Based on this mapping process, the total eligible pool of researchers and decision-makers was estimated at approximately sixty individuals, and efforts were made to contact the majority. This sample size is comparable to those reported in similar studies conducted in other Arab countries (Reference Almazrou, Alaujan and Al-Aqeel10).
The survey was conducted using Google Forms. Eligible participants were invited via WhatsApp or email and provided with an information sheet and a survey link. Two reminder emails were sent at one-week intervals to improve the response rate.
Study questionnaire
The questionnaire comprised five sections. The first section collected demographic and professional information, including age, gender, qualifications, affiliations, number of HTA/economic evaluation publications, and years of experience in the field. The second and third sections assessed the respondents’ perceived barriers and facilitators to conducting HTA (i.e., study design, data collection, analysis, and reporting) (Reference Kim, Kim and Lee11). The fourth and fifth sections assessed the perceived barriers and facilitators to HTA implementation (i.e., its use in the decision-making process) (Reference Almomani, Alabbadi and Fasseeh8). The questionnaire was developed based on an extensive literature review (Reference Kim, Kim and Lee11–Reference Williams and Bryan13), identifying nineteen and twelve potential barriers to conducting and implementing economic evaluations, respectively, and eleven and ten potential facilitators, respectively.
Responses were rated on a five-point Likert scale (“strongly disagree” to “strongly agree”), followed by selection of the three most important barriers and facilitators from the list. Open-ended questions were included at the end of each section to gain additional input on perceived barriers and facilitators. The study questionnaire is presented in Supplementary File 1.
Questionnaire validity
The face and content validity of the questionnaire were assessed by two local experts in health economics (one academic and one decision-maker) to ensure relevance and clarity of the terminology in the Jordanian context. The experts were asked to evaluate face validity by assessing the clarity of the questionnaire and to determine its content validity by indicating whether all relevant barriers and facilitators were included, suggesting pertinent new items, or eliminating irrelevant items. Upon accessing the survey link, participants were directed to an information page outlining the study objectives, voluntary participation, confidentiality, and the intended use of the data for research purposes. Participants were required to provide informed consent by confirming that they had read the information sheet and agreed to participate before proceeding with the questionnaire.
For quality assurance, an additional confirmation item was included at the end of the survey to verify that participants had carefully read and understood the questionnaire and consented to the use of their data. Responses lacking this final confirmation were excluded.
Ethical considerations
Ethical approval was obtained from the Institutional Review Board of the University of Jordan (IRB: 1359/2024/19). This study adhered to the ethical principles outlined in the Declaration of Helsinki.
Data analysis
All statistical analyses were performed using SPSS version 27 (Reference Amiri, Al Nsour and Alonso-Garbayo26). Data were initially screened for completeness, consistency, and accuracy. Categorical variables, including demographic and professional information, were presented as frequencies and percentages. Although Likert-scale responses are ordinal by nature, they were treated as quasi-interval variables for analysis – a common approach for scales with five or more categories. Consistent with Item Response Theory (Reference Harwell and Gatti14;Reference Cohen15), such scales allow approximation of interval-level measurement. Given the symmetric scaling and limited number of response categories, this approach is unlikely to introduce substantial bias and enables the calculation of means and medians for interpretation and comparison.
Results
Participant characteristics
A total of fifty-eight eligible individuals were contacted, of whom fifty-three responded to the survey; two responses were excluded because the respondents were unwilling to share their data for research purposes. This yielded a final sample size of fifty-one participants, including twenty-eight researchers (54.9 percent) and twenty-three decision-makers (45.1 percent). The demographic and professional characteristics of the participants are presented in Table 1.
Sociodemographic and professional characteristics of the study population, stratified by decision-maker, and researcher
Table 1. Long description
The table presents data for 51 participants (28 researchers and 23 decision-makers). Key findings include:
* Age: The majority of participants are aged 35 to 44 (56.9 percent total). Researchers are concentrated in the 35 to 44 bracket (64.3 percent), while decision-makers are more distributed across 25 to 54.
* Gender: The total population is 62.7 percent female and 37.3 percent male. Decision-makers are predominantly female (78.3 percent), while researchers are evenly split (50 percent).
* Academic Degree: 85.7 percent of researchers hold a P h D, whereas 73.9 percent of decision-makers hold a Masters degree.
* Country of Last Degree: Jordan is the most common location (51 percent total), followed by the U K (27.5 percent). 46.4 percent of researchers earned their degree in the U K.
* Experience: 53.6 percent of researchers have 6 to 10 years of experience in economic evaluations. 56.5 percent of decision-makers have 1 to 5 years of experience.
* Economic Evaluations (Past 10 Years): 60.7 percent of researchers have assessed or reviewed more than 6 evaluations. For published evaluations, 100 percent of decision-makers reported zero, while 64.2 percent of researchers have published between 1 and 6. For unpublished evaluations, 46.4 percent of researchers and 30.4 percent of decision-makers have conducted 1 to 2.
Barriers to conducting HTA
Both researchers and decision-makers agreed that the two primary barriers to conducting HTA were “lack of routinely collected local effectiveness data and national health statistics” and “absence of relevant health state preference values to estimate QALYs,” as evidenced by the mean values reported in Table 2 (researchers, mean = 4.21; decision-makers, mean = 3.78; out of a maximum of 5). In addition, both groups identified “lack of information on healthcare resources used by patients” as the third most important barrier (35.7 percent of researchers and 26.0 percent of decision-makers). In the open-ended questions, seven participants mentioned additional barriers to conducting HTA. These included “insufficient interprofessional collaboration” (n = 2), “lack of pregraduation classes in HTA” (n = 1), and “restrictive government legal instructions” (n = 1). Participants also reported that health economists in the region often relied on estimated data rather than valid local data (n = 1). Other barriers included differences in costs between sectors (n = 1) and limited awareness of the importance of economic models (n = 1).
Barriers to conducting HTA in Jordan for researcher and decision-maker subgroups (n = 51)
Table 2. Long description
The table presents 19 barrier statements related to conducting H T A (Health Technology Assessment) in Jordan. For each statement, data is split into two main columns: Decision-maker and Researcher. Each subgroup includes Likert scale percentages (Strongly disagree, Disagree, Neutral, Agree, Strongly agree), the number and percentage selected as a top-three barrier, and summary statistics (Mean with S D and Median).
Key data points include:
* Lack of routinely collected local effectiveness data: Selected as a top-three barrier by 10 decision-makers (43%) and 17 researchers (61%). Both groups have a median score of 4.
* Absence of a relevant health state preference to estimate Q A L Y s: Selected as a top-three barrier by 5 decision-makers (22%) and 9 researchers (32%).
* Fragmentation of the healthcare system: Selected as a top-three barrier by 6 decision-makers (26%) and 7 researchers (25%).
* Lack of good quality local national level databases: Selected as a top-three barrier by 5 decision-makers (22%) and 9 researchers (32%).
* Limited qualified human resources: Selected as a top-three barrier by 6 decision-makers (26%) but only 1 researcher (4%).
* Lack of information on healthcare resources used by patients: Selected as a top-three barrier by 6 decision-makers (26%) and 10 researchers (36%).
Most barriers show a median score of 4 (Agree) across both subgroups, indicating broad consensus on the challenges, particularly regarding data availability, quality, and system fragmentation.
Facilitators for conducting HTA
The highest-rated facilitator for conducting HTA was “the construction of a good-quality real-world database at the national level,” as evidenced by the mean values reported in Table 3 (researchers, mean = 4.39; decision-makers, mean = 4.09). Moreover, both groups selected “availability of a good-quality data warehouse containing healthcare resource details, such as hospital admissions, diagnoses, and procedures” as the second most important facilitator (53.6 percent of researchers and 39.1 percent of decision-makers). However, researchers identified “accessibility to routinely collected effectiveness datasets” as the third facilitator (46.4 percent), whereas decision-makers identified “availability of methodological guidelines specific to Jordan” (47.8 percent). In the open-ended questions, four participants suggested additional key facilitators to enhance HTA conduct in Jordan. These included “strengthening and empowering key institutions such as the Jordan Food and Drug Administration, JPD, and the Government Health Insurance Department”; “promoting collaboration between health economists and other experts”; “establishing a HTA Unit in every health department, association, hospital, and research center to ensure localized and systematic implementation of HTA”; and “prioritizing budget impact analysis to guide the adoption of new technologies based on financial feasibility” (Table 3).
Facilitators to conducting HTA in Jordan for researchers and decision-makers subgroups (n = 51)
Table 3. Long description
The table compares 11 facilitator statements for conducting H T A (Health Technology Assessment) in Jordan between two subgroups: Decision-makers and Researchers (n = 51).
For each statement, data includes percentage and count for agreement levels (Strongly disagree, Disagree, Neutral, Agree, Strongly agree), the number and percentage selected as a top-three facilitator, and summary statistics (Mean with S D and Median).
Key statements and their top-three selection highlights include:
* Construction of a good-quality, real-world database: Selected as top-three by 13 (57%) decision-makers and 22 (79%) researchers.
* Availability of a good quality data warehouse: Selected as top-three by 9 (39%) decision-makers and 15 (54%) researchers.
* Accessibility to routinely collected effectiveness data sets: Selected as top-three by 5 (22%) decision-makers and 13 (46%) researchers.
* Availability of methodological guidelines specific to Jordan: Selected as top-three by 11 (48%) decision-makers and 4 (14%) researchers.
* Sufficiently qualified human resources and expertise: Selected as top-three by 9 (39%) decision-makers and 3 (11%) researchers.
* Establishment of an independent society for health economic research: Selected as top-three by 8 (35%) decision-makers and 3 (11%) researchers.
Other statements regarding access to healthcare resources, local tools like E Q - 5 D utility scores, unifying clinical practices, professional development, and financial support generally show high agreement (median of 4 for both groups) but lower frequency in top-three selection.
Barriers to HTA implementation
Researchers identified “abundance of incentive to a physician for a particular intervention in the healthcare system” as the primary barrier (mean = 3.79) to HTA implementation in Jordan, whereas decision-makers highlighted “lack of formal willingness-to-pay (WTP) threshold ranges or thresholds by disease categories” as the single most important barrier (mean = 3.68). In addition, both groups emphasized that “limited abilities of decision-makers to shift resources supported by the HTA studies across healthcare sectors” (67.9 percent of researchers and 60.9 percent of decision-makers) and “lack of support from decision-makers” (50.0 percent and 30.4 percent, respectively) were among the top three barriers (Supplementary File 2).
Facilitators for HTA implementation
Both groups identified the single most important facilitator for HTA implementation as “economic evaluations should be prioritized and focus on interventions that would assist decisions targeting major health problems” (researchers, mean = 4.25; decision-makers, mean = 4.13). Additional facilitators identified by both groups among the top three facilitators included “engagement of policymakers with the researcher during the conducting of the HTA process” (57.1 percent of researchers and 34.8 percent of decision-makers) and “establishing a country-specific WTP threshold categorized by disease” (50.0 percent and 30.4 percent, respectively) (Supplementary File 3).
Discussion
This study provides comprehensive, stakeholder-informed insights into barriers and facilitators for conducting and implementing HTA in Jordan. Decision-makers and researchers often play pivotal roles in translating economic evidence into policy. By incorporating both researchers’ and decision-makers’ perspectives, this study highlights the key contextual challenges and opportunities for HTA within the Jordanian healthcare system. Understanding these barriers and facilitators is essential for developing context-specific frameworks aligned with the country’s structural and economic landscape (Reference Suharlim, Kumar and Salim16).
Conducting economic evaluations is primarily constrained by the limited availability and accessibility of high-quality local data and centralized data on healthcare resources, reflecting the fragmented data systems in Jordan (Reference Hammad, Alabbadi and Taissir17). This aligns with evidence from other LMICs identifying inadequate local clinical data and insufficient contextual inputs as major technical barriers (Reference Daccache, Rizk and Dahham18–Reference Naser21). Previous studies have outlined the importance of collaboration and data availability as key facilitators for economic evaluations in the Gulf Cooperation Council countries (Reference Almazrou, Alaujan and Al-Aqeel10). Thus, fostering collaboration and strengthening data-sharing mechanisms can not only improve HTA quality but also facilitate the transferability of economic evaluations across similar healthcare systems, both regionally and globally (Reference Almazrou, Alaujan and Al-Aqeel10;Reference Adeagbo, Rattanavipapong, Guinness and Teerawattananon22).
The absence of standardized practices further complicates the challenges associated with HTA. This has also been outlined in studies conducted in Europe and other countries. Therefore, developing centralized and systematically collected databases, as well as context-specific decision-making frameworks, is recommended to enable comprehensive evaluations. Standardized adaptive methodologies for local contexts are warranted to enhance data transferability across settings and providers (Reference Fasseeh, Karam and Jameleddine6;Reference Nemzoff, Ruiz and Chalkidou23). Moreover, developing methodological guidelines tailored to the Jordanian context has been identified as a key facilitator for the use of economic evidence. Such guidelines can serve as a standardized framework for conducting evaluations, ensuring consistency and reliability across studies, and enhancing data transferability and comparability across regions (Reference Fasseeh, Karam and Jameleddine6).
Another barrier is the variation in clinical practice, which increases the complexity of selecting appropriate perspectives and limits the generalizability of findings across providers in Jordan. National clinical practice guidelines and local disease management pathways are, therefore, essential to reduce variability in clinical and cost data and to improve the comparability of economic evidence (Reference Lipska, Di Bidino and Niewada24). Promoting collaboration between health economists and stakeholders was also identified by decision-makers as a key facilitator. Engaging multidisciplinary teams can bridge knowledge gaps and foster shared expertise, particularly in settings where HTA is institutionalized (Reference Lipska, Di Bidino and Niewada24). As a decision-making framework, HTA can provide the institutional support necessary to sustain collaborations and ensure the systematic implementation of economic evidence. These findings align with prior recommendations emphasizing stakeholder engagement and capacity building to enhance the integration of economic evaluations into public decision-making.
With respect to the implementation of economic evaluations within HTA, the absence of a formal WTP threshold is a major challenge. Although the King Hussein Cancer Center has developed a cost-effectiveness threshold for oncology, no national WTP threshold currently exists in Jordan (Reference Treish, Al Rabayah, Jaddoua and Tuffaha25). This uncertainty regarding the valuation of outcomes may also hinder the systematic and transparent assessment of cost-effectiveness (Reference Hammad, Alabbadi and Taissir17;Reference Nemzoff, Ruiz and Chalkidou23;Reference Treish, Al Rabayah, Jaddoua and Tuffaha25). Establishing a threshold would provide a clear benchmark for decision-making and improve transparency and consistency in resource allocation decisions across providers.
Capacity-building strategies should extend beyond awareness to include structured and sustainable initiatives, such as formal training fellowships and postgraduate programs in health economics and HTA, to better support HTA implementation. In parallel, continuous professional development programs for healthcare providers and policymakers, along with the institutionalization of HTA units within major public healthcare providers in Jordan (such as the MOH), would enhance the use of HTA evidence in decision-making and strengthen its integration into policy and practice.
Operational challenges were also noted by decision-makers, particularly the limited ability to shift resources across healthcare sectors, which complicates the implementation of economic evidence within HTA activities. These challenges reflect broader governance limitations in budgeting and priority setting, which are commonly observed in developing healthcare systems such as those in Jordan. As highlighted by the World Health Organization, inefficiencies in resource allocation and a lack of transparent budgeting mechanisms can undermine the effectiveness of health interventions. Therefore, strengthening governance frameworks and providing clear guidance on the transferability of economic evaluations are essential to enable HTA to inform resource allocation decisions more effectively (Reference Almazrou, Alaujan and Al-Aqeel10;Reference Amiri, Al Nsour and Alonso-Garbayo26;Reference Balkhy27–Reference Merlo, Page, Ratcliffe, Halton and Graves29).
In this study, researchers identified “lack of routinely collected local effectiveness data and national health statistics” and “absence of relevant health state preference values to estimate QALYs” as the two primary barriers to conducting HTA. However, the EQ-5D-3L value set for generating utilities has been published recently (Reference Al Rabayah, Roudijk and Purba30). An additional barrier was the lack of information on healthcare resources used by patients. The national health information system of Jordan, “Hakeem,” has automated health records across more than 225 public healthcare institutions within the two main public providers, the MOH and the Royal Medical Services (RMS). This extensive digital infrastructure offers a valuable source of real-world data on healthcare utilization, costs, and outcomes that could substantially strengthen HTA. However, the Hakeem system remains underutilized for research and evidence generation, limiting its contribution to evidence-informed decision-making. This underutilization represents a missed opportunity to generate robust, patient-level cost data to support HTA in Jordan.
This study has several contextual strengths. It incorporates perspectives from both decision-makers and researchers, providing a comprehensive, stakeholder-informed view of HTA in Jordan. It also offers context-specific insights into real-world barriers and facilitators to HTA conduct and implementation, enhancing its relevance to both policy and practice. These findings are valuable for informing international audiences about the practical, context-specific challenges and opportunities associated with HTA implementation in resource-constrained settings while also providing local policymakers with actionable insights to strengthen data systems, governance structures, and capacity-building efforts. “A further strength of this study is the high participation rate, with fifty-one respondents representing approximately 85 percent of the estimated eligible HTA researchers and decision-makers in Jordan, supporting the breadth of perspectives captured.”
However, several limitations also need to be acknowledged. First, the use of purposive sampling may have introduced selection bias, and self-reported measures may be subject to response bias. Nevertheless, the inclusion of key stakeholders directly involved in HTA, along with the consistency of findings across groups, strengthens the relevance and credibility of the results. The structured survey design may also have limited participants’ ability to express nuanced perspectives on additional barriers and facilitators. Future studies should employ mixed-methods approaches, including qualitative components, to provide a deeper understanding of stakeholder perspectives and uncover additional context-specific factors that influence HTA practice and implementation.
Furthermore, the relatively narrow range of mean and median scores (approximately 3.5–4.5 out of 5) across all identified barriers and facilitators warrants careful interpretation. While this may reflect a genuine consensus among participants regarding their importance, it is unlikely that all factors are perceived as equally important in practice. Possible explanations include conceptual overlap among questionnaire items, which may have led respondents to assign similar ratings to closely related constructs. Moreover, limited variability in responses may reflect the high perceived importance of the included barriers and facilitators among participants and may also indicate a potential ceiling effect associated with the use of a five-point Likert scale.
The demographic characteristics of participants indicate differences in training background between the two groups. A larger proportion of researchers reported receiving their training in the United Kingdom (UK), whereas decision-makers were predominantly trained in Jordan. This variation may help to contextualize the findings, as exposure to HTA methodologies and economic evaluation frameworks, including WTP approaches, is more commonly embedded within UK-based training programs. Such differences in educational background may have influenced participants’ familiarity with and interpretation of HTA concepts, and should be considered when interpreting the observed results.
Based on these findings, we recommend increasing access to high-quality real-world data to enhance the conduct of HTA. Thus, there is a need to develop a strategic data plan in collaboration with relevant stakeholders to identify the major sources of real-world data and establish processes for their access and use. For example, leveraging the Hakeem system to validate available data and assess its usability could substantially strengthen HTA capacity.
In addition, it is recommended to improve shared decision-making among healthcare providers based on HTA findings and establish a country-specific WTP threshold stratified by disease. Strengthening collaboration between decision-makers and researchers is likely to facilitate HTA implementation at the national level. Longitudinal studies are also needed to monitor progress in HTA conduct and implementation and to evaluate the challenges faced by HTA, as well as the success of its implementation.
Furthermore, future studies could employ Delphi surveys to better differentiate the relative importance of identified barriers and facilitators. The Delphi technique is a structured, iterative process designed to achieve a reliable consensus among a panel of experts (Reference Shang31). Through sequential rounds of questionnaires with controlled feedback, this method would enable a more granular exploration and hierarchical ranking of the factors. This approach has been successfully applied in other LMICs to reach a consensus on HTA frameworks and establish health policy priorities, making it a valuable next step for HTA development in Jordan (Reference Alnaqbi, Elshamy and Gebran32;Reference Behzadifar, Bakhtiari and Shahabi33). Finally, sustainable HTA implementation will require diverse funding sources, including public sector support (e.g., MOH, RMS, and the High Health Council), international donors (e.g., WHO and USAID), academic research grants (e.g., the University of Jordan), and, to a lesser extent, private sector contributions.
Conclusion
This study highlights important perspectives from both decision-makers and researchers on the current conduct and implementation of HTA in Jordan. While progress has been made, HTA application remains constrained by structural, methodological, and data-related challenges, alongside opportunities for improvement in governance, stakeholder coordination, and capacity development.
To strengthen HTA integration in decision-making, Jordan should prioritize the establishment of a formal, institutionalized HTA framework with a clearly defined mandate and governance structure. In parallel, investment in robust and interoperable national data systems is essential to support high-quality economic evaluations and evidence generation. Finally, sustained capacity-building initiatives embedded within regulatory, academic, and reimbursement institutions are needed to ensure the long-term institutionalization and effective use of HTA in resource allocation decisions.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1017/S0266462326104231.
Data availability statement
Data supporting the findings of this study are available from the corresponding author upon request.
Acknowledgments
We thank the Investigator Support Unit (ISU), Prince Naif Health Research Centre, for the language-editing support provided.
Author contribution
R.H.M. conceptualized and conducted the study, developed and validated the survey, and collected, analyzed, and interpreted the data. R.H.M., S.M., S.S.A., S.A., E.A., A.A.-R., E.A.H., R.M.A., I.A., and A.Y.N. validated the questionnaire and wrote the first draft of the manuscript. All authors reviewed the manuscript for important intellectual content and approved the final version for publication. All authors agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.
Funding statement
This study was supported by the Deanship of Scientific Research at the University of Jordan (Grant No. 293-2023/2024).
Competing interests
The authors declare none.
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