Multicriteria health technology assessments for high-cost oncology drugs in Peru: an analysis of records from RENETSA, the national network for health technology assessment

Abstract

Introduction: Multicriteria health technology assessment (HTA) formally integrates multiple
criteria to support evidence-informed health decision-making. In Peru, HTAs are conducted by the National Network for Health Technology Assessment (RENETSA, by its Spanish acronym).Objective: To describe the characteristics of HTA reports on oncologic treatments developed by RENETSA and to explore the relationship between the evaluated criteria and the final recommendation. Material and Methods: A cross-sectional study was conducted based on HTA reports published by RENETSA up to December 31, 2024. Clinical, methodological, and institutional variables, as well as those related to the assessment of health technologies in the evaluation process, were analyzed. The association between decision criteria and the final recommendation was examined using bivariate statistical tests (chi-square and Mann–Whitney U). Results: A total of 61 reports were included. Of these, 32.8% received a recommendation in favor. Clinical need (p = 0.003), magnitude of desirable effects (p < 0.001), undesirable effects (p = 0.008), balance of effects (p < 0.001), and equity impact (p < 0.001) were significantly associated with recommendations in favor. The domains most frequently leading to decreased certainty of evidence were imprecision and risk of bias. Effect size thresholds were used as imprecision thresholds in all evaluated reports. Conclusions: Most reports issued by RENETSA presented a recommendation against. The criteria most strongly associated with recommendations in favor were clinical need, desirable effects, positive balance of effects and improvement in equity. It is also suggested to develop effect size 
thresholds by cancer type and validate them through clinical expert consensus.