Overview
In Lebanon, we co-developed the first formal Health Technology Assessment (HTA) framework for the National Social Security Fund (NSSF), establishing a structured and institutionalised process for reimbursement decisions. The framework was developed in collaboration with the NSSF Pharmacy Department and is presented as an official national HTA guidebook.
Guided by the principles of Evidence-Informed Deliberative Processes (EDPs), the framework introduces explicit decision criteria, structured assessment and appraisal stages, and defined procedural steps for evaluating new health technologies. It constitutes a foundational step toward institutionalising transparent and standardised reimbursement decision-making within the NSSF.
Approach & Methods Used
Working closely with the NSSF, we:
- Designed a formal HTA process including nomination, scoping, assessment and appraisal stages
- Introduced explicit decision criteria: safety, incremental clinical benefit and budget impact
- Structured appraisal around a deliberative decision tree
- Embedded stakeholder communication and procedural transparency
- Developed practical guidance for applicants submitting reimbursement requests
- Established monitoring and process evolution mechanisms
The framework balances methodological rigour with the fiscal realities of Lebanon’s economic crisis, prioritising cost-neutral or cost-saving technologies while gradually building institutional HTA capacity.
Significance
This guidebook represents the first published HTA framework in Lebanon and formalises decision-making processes that were previously implicit. It positions the NSSF to transition progressively toward a more comprehensive HTA system, including future integration of cost-effectiveness analysis.
The Lebanon case demonstrates how EDP-based governance design can serve as an entry point for institutionalising HTA in fiscally constrained and politically complex environments.
Collaborating Partners
- National Social Security Fund (NSSF)
- Roche
Related Publications & Reports
- National Social Security Fund. A guide to health technology assessment at the National Social Security Fund. Lebanon: National Social Security Fund; 2023.
