A deep dive into Brazilian health technology assessment: Structure, policies, and processes.

Healthcare systems worldwide face mounting pressures from aging populations, costly medical technologies, and rising healthcare expenditures. Health Technology Assessment (HTA) has emerged as a critical tool for improving efficiency and supporting evidence-informed resource allocation through systematic evaluation. In Brazil, HTA plays a central role in advancing Universal Health Coverage (UHC), particularly through the National Committee for Health Technology Incorporation (Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde - CONITEC). As HTA continues to evolve in Brazil, there is an increasing need for health policy and systems research to better understand its structure, challenges, and opportunities. This study aimed to comprehensively analyze the key pillars of Brazil's national HTA system, identify existing barriers, and propose strategies to strengthen HTA processes. A mixed-methods approach was employed between 2021 and 2023, targeting HTA-related organizations and experts across multiple health sectors. Data were collected through thirteen electronic institutional surveys assessing technical aspects of HTA and nine virtual in-depth interviews exploring HTA from a policy perspective. Findings indicate a strong presence of public-sector and academic institutions within Brazil's HTA landscape, alongside broad recognition of HTA's value and CONITEC's central role in coordinating evidence generation and appraisal. However, challenges such as potential conflicts of interest and reliance on exclusive government funding were identified, underscoring the need for more diversified and sustainable financing mechanisms. The system benefits from a multidisciplinary workforce and active community participation, and HTA evidence is widely used in policymaking, particularly in evaluating clinical effectiveness, costs, and economic value. Despite these strengths, limitations persist, including insufficient institutional capacity, resource constraints, and political support. Participants emphasized the need to strengthen HTA skills, competencies, and coordination to improve the effectiveness and impact of HTA processes. This study contributes to the limited literature on Brazil's HTA system and provides evidence to inform future research and policy efforts aimed at strengthening HTA integration in support of UHC.