Beyond Recommendations: A Systematic Review of Values, Outcomes and Impact of Health Technology Assessment Agencies Worldwide

IntroductionHealth Technology Assessment (HTA) agencies are increasingly required to demonstrate their added value for health systems, yet evidence on their real-world performance remains limited and heterogeneous.This systematic review aimed to describe the characteristics, perceived value, outcomes and impact of governmental HTA bodies worldwide. MethodsWe searched biomedical databases, registries, grey literature and websites of HTA agencies and international networks, without language or date restrictions, following Cochrane and PRISMA guidance.Eligible documents reported empirical data or structured opinions on governmental HTA agencies whose role is defined in law or equivalent regulation and/or whose recommendations are binding or otherwise mandatory for at least one health subsystem; purely theoretical pieces and non-governmental initiatives were excluded.A qualitative narrative and thematic synthesis was undertaken. ResultsWe identified 56 governmental HTA agencies, 43 established by law, operating across diverse regions and health-system arrangements.Stakeholders consistently valued these agencies for credibility, scientific rigor and their contribution to transparent, equity-oriented priority setting.Quantitative evidence showed wide variation in HTA report production, economic effects and influence on technology adoption, clinical practice and budgetary outcomes, with some agencies generating substantial savings and shaping coverage and disinvestment decisions.Impact was often indirect, context-dependent, more frequently documented at policy than clinical level.Long-term and equity-focused outcomes were sparsely reported. DiscussionOverall, HTA agencies mandates and binding recommendations by law are perceived as key contributors to evidence-based, equitable resource allocation, but https://doi.org/10.