Framing the Canadian Health Technology Assessment as an Organisational Process: A Bibliometric Analysis.

Health Technology Assessment (HTA) is an organizational process used to determine the value of health-technologies. There is considerable variation in how HTA is developed globally, with Canada at the forefront of this field, having pioneered the use of HTA and implemented it extensively across healthcare organisations at all levels. This study is relevant for its unique focus on citation networks and author keywords regarding HTA in Canada, providing a holistic view by analysing HTA as an organizational process. By identifying fundamental process elements and differentiating research streams (RSs), it addresses a notable gap in the literature, offering fresh insights and informing policy recommendations to enhance HTA practices. While referring to the Canadian HTA, this study conducts a Systematic Literature Network Analysis to identify the RSs that will be analysed according to a process perspective. This analysis allows highlighting the process components-like stakeholders, phases, and methods-that have played a role in the success of Canada's HTA, as well as pinpointing the ongoing challenges that need to be tackled to create greater value. Analysing documents published in peer-reviewed English-language journals from the Scopus-Elsevier database, we identified seven RSs, including macro-HTA, meso-HTA, micro-HTA, ethical considerations, and patient involvement. For each stream, this study delineates the process elements, that is, the involved stakeholders, process phases, methodologies, and evaluation criteria. It is evident that while expert panels and specialist groups are crucial for technical HTA activities, patients and caregivers play a pivotal role in social and ethical evaluations. The study also highlights future challenges for HTA procedures: integrating qualitative and quantitative considerations, assessing the real impact of macro-HTA outputs, and overcoming barriers to patient involvement. Theoretically, this paper clarifies the differences between streams in terms of HTA process elements, and practically, it assists practitioners in tailoring the HTA process to their specific needs. Policymaking recommendations include considerations regarding the number and intensity of stakeholder engagement.