Comparative analysis of health technology assessment and health economic evaluations in Western Balkan countries versus Albania

Abstract

Health Technology Assessment (HTA) and health economic evaluations are key instruments for evi - dence-based decision making in health systems facing increasing budgetary pressure. HTA supports transparent and rational allocation of limited resources by assessing the clinical, economic, ethical and social value of health technologies. This paper compares the development and practical use of HTA and health economic evaluations in Western Balkan countries and Albania. A narrative review of World Health Organization (WHO) reports and peer-reviewed studies was conducted. Results show that Serbia and Croatia have established early legal and institutional frameworks for HTA, while Bosnia and Herze- govina recognizes HTA in legislation but lacks functional implementation structures. Across the region, health economic evaluations are mainly applied in reimbursement decisions for medicines but are rarely used systematically in broader health policy. Albania remains at the earliest stage of HTA development, with no formal national HTA agency and limited use of standardized economic evaluations. The findings highlight major gaps in institutional capacity, legal frameworks and data availability. Strengthening HTA structures, harmonizing evaluation standards and promoting regional cooperation could significantly im- prove transparency, efficiency and equity of health spending decisions. The study concludes that Albania lags behind neighboring countries in formal HTA implementation and requires urgent policy action to align with European standards.