Regional HTA in Italy: promising or confusing?

We assessed the actual implementation and achievements of regional HTA in Italy. We conducted a web-based analysis (updated until July 2012). Six key elements were identified: availability of official documents, existence of a specific workgroup, involvement of external organizations, formal funds for HTA, publication of HTA reports, and membership of HTA networks. Then, we searched all HTA reports retrieved by key words to analyze whether their contents included clinical efficacy, economic evaluation, legal issues, ethics and organization. Two researchers analyzed the information separately, as a double check. Sixteen regions have formally established a structured workgroup inside their organizations. Specific funding for HTA activities could be traced in six regions, web-available reports only in four. Around 91% of the total reports concerned drugs. Contents mostly focused on epidemiological and clinical issues, economic evaluation was often restricted to a brief analysis of costs. Only a few reports mentioned organizational implications; ethical, legal and social issues were lacking. This survey showed a very uneven picture of HTA in the Italian regions. As expected, not all the regions were able to perform HTA, probably on account of their wide differences in size, tradition and skills in the health care field.