Background and Rationale
Like many other countries, Austria has faced steadily rising pharmaceutical expenditures, particularly in the hospital sector, where gene therapies and other highly specialized medicines are generating significant financial pressure. While outpatient reimbursement decisions are centralized through the positive list of SHI funds (Erstattungskodex), coverage for inpatient medicines has historically been fragmented, varying across regional hospital associations. Given that the lack of a national Health Technology Assessment (HTA) process for hospital medicines could lead to possible regional discrepancies in patient access, Austria introduced the Austrian Appraisal Board (Bewertungsboard). This national expert committee, tasked with evaluating selected high-priced and specialized medicines used in hospitals and at the interface with outpatient care, began its work in September 2024.
Objectives
The board pursues several interrelated aims:
- Equitable and timely patient access to specialized medicines.
- Uniform and appropriate use of high-cost pharmaceuticals across Austria.
- Efficient allocation of resources, ensuring long-term financial sustainability of the health system.
- Support for clinicians and hospitals in adopting new technologies through evidence-based recommendations.
Composition and Workflow
The composition of the board reflects Austria’s pluralistic approach to health governance. Besides representatives from the Federal Ministry of Health, the national public health institute, and the national regulatory agency, it includes delegates from all nine federal regions and the social health insurance institutions, as well as representatives from academia (clinical pharmacologists) and one patient advocate.
The Austrian Appraisal Board meets five times annually. Its corresponding process spans approximately five months and includes:
- Selection of health technologies (identification of medicines via horizon-scanning activities, joint clinical assessments (JCA) and stakeholder reports).
- Conduction of HTA (taking JCA into account, if available), covering clinical and non-clinical aspects (e.g., cost-effectiveness, ethical, organizational, and social aspects).
- Expert and patient involvement.
- Price negotiations with marketing authorization holders.
- Board recommendation, published as an expert opinion paper on the Ministry’s website.
Results
One year after its establishment, the board had selected six medicines for evaluation. The next steps include expanding evaluations to medicines at the outpatient-inpatient interface and scaling up the number of assessments conducted annually.