Health technology assessment system in Switzerland: Current state, gaps, and prospects for improvement.

Switzerland maintains a distinct HTA system that often aligns with EU requirements and reflects its unique healthcare governance model, with structured processes led by the Federal Office of Public Health (FOPH), despite lacking a comprehensive national framework. These processes, though sometimes limited in scope, produce nationally binding decisions. This study aims to comprehensively analyze and understand the key pillars of the national HTA system, identify obstacles, and propose insights to strengthen the HTA system in Switzerland. This system analysis study was conducted between 2021 and 2023, targeting key Swiss HTA-associated organizations and experts from various health sectors. Mixed methods were used to gather data using electronic institutional surveys completed by nine organizations to assess HTA technical aspects and virtual in-depth interviews (IDIs) with eight experts to understand HTA from a policy perspective. The study examined HTA practices in the Swiss organizations, comprising 67% academic, 22% public, and 11% non-governmental sectors. Findings revealed that 67% of the organizations mentioned that structured processes were led by the FOPH as the central agency (67%). While 56% (n = 5) of organizations reported substantial funding, challenges included a lack of government funding. In Switzerland, HTAs most frequently addressed safety, clinical effectiveness, and economic aspects, while social acceptability and feasibility were less commonly considered. Strong interest in expanding HTA capacity was expressed. However, there is limited awareness and advocacy for HTA, insufficient political support, limited institutional capacity, and persistent gaps in funding. The study highlights the importance of HTA in healthcare decision-making and resource allocation in Switzerland, and the need for addressing the integration gap of HTA into decision-making. Enhancing awareness and institutional strengthening are key to advancing HTA. This study offers insights to guide future research and to establish a national HTA agency, to improve integration and coordination of HTA across all Swiss Cantons.