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INTRODUCTION: Health technology assessment (HTA) can increase the appropriateness and transparency of pricing and reimbursement decisions. However, Jordan is still in the early phase of its HTA implementation, although the country has very limited public resources for the coverage of health care technologies. Objectives: To explore and validate priorities in HTA roadmap for Jordan and propose a draft action plan to achieve the preferred future HTA status. Methods: Health policy experts from the public and private sector were asked to fill in an international scorecard to explore the current and future status of HTA implementation in Jordan. Semi-structured interviews with senior policy-makers supported by literature review were conducted to validate survey results and set up a draft action plan. Results: Key results were derived from 22 valid survey responses and interviews with 8 policy-makers. Survey and interview results confirmed the need for 1) increased HTA training, including shorts courses and academic programs; 2) gradually increasing public funding for HTA; 3) establishment of multiple HTA bodies with central coordination; 4) extending the scope of HTA to nonpharmaceutical technologies; 5) strengthening cost-effectiveness criterion with explicit thresholds; 6) improvement in HTA quality and transparency with methodological guidelines and published HTA reports and recommendations; 7) increased utilization of local data; 8) participation in international joint HTA work. Conclusions: Currently, HTA has limited impact on health policy decisions in Jordan, and when it is used to support pharmaceutical reimbursement decisions, it is mainly based on results from other countries without considering transferability of international evidence. Policymakers should facilitate HTA institutionalization and use in policy decisions by increasing the weight of local evidence in HTA recommendations.

2009, NICE issued supplementary 'End of Life' (EoL) guidance allowing technologies that may extend the life ("normally of at least an additional 3 months" versus current NHS treatment) of people with life-threatening illnesses (,24 months life expectancy) to be assessed at a higher threshold (w£50,000/QALY). This research aims to evaluate whether NICE accounts for relative survival benefits in implementing the $3 months survival EoL criterion. Methods: NICE single technology appraisal (STA) guidance for oncology drugs was screened (01/01/2009-17/10/2018) and EoL consideration data extracted alongside the pivotal trial OS Hazard Ratio (HR) benefit. Results: 165 STA-recommendations were identified (51% recommended, 18% optimized, 8% recommended for the Cancer Drugs Fund, and 23% not recommended). EoL criteria were discussed in 60% (99/165) of appraisals and were deemed to apply in 65% of cases (64/99, 94% of which were recommended/optimized). In 24% (24/99), EoL criteria were discussed where the mOS benefit was ,3 months. Nevertheless, in 50% (12/24) of these, EoL criteria was deemed to have been met. There exists a clear OS HR threshold of 0.71 below which NICE will accept a ,3 months mOS benefit to satisfy EoL criteria (5/5 accepted) and likely to reject above a threshold of 0.79 (8/9 rejected), with no consensus between 0.72-0.78 (6/10 accepted). Additionally, in 16 STAs, no supportive comparative data were available, yet in 75% (12/16) of cases EoL criteria was deemed to have been met. Conclusions: NICE are willing to be flexible in their $3 month OS benefit requirement, not just accepting lower absolute benefits that demonstrate large changes in relative survival but also allowing drugs without any comparative data to satisfy this EoL criterion.

prostatectomy (change: 1.389 QALY), proportions of distant metastasis (change: -0.930 QALY) and high-risk patients (change: 0.641 QALY), and treatment effect of radical prostatectomy (change: -0.593 QALY). The lifetime direct medical costs associated with PC patients was highly sensitive to mortality (change: U-67,231) and treatment effects of surgical castration therapy (change: U-50,422), brachytherapy combined with external beam radiation therapy (change: U47,440), and androgen deprivation therapy (change: U-41,375). The probabilistic sensitivity analysis with 5,000 Monte Carlo simulations estimated the median and 95% credible interval of reduced QALY (-1.813 QALY, -2.382 to -1.154 QALY) and increased lifetime direct medical costs (U283,506, U210,436 to U405,878). Conclusions: The disease burden of PC in Chinese patients was mainly characterized with increased medical costs that were highly sensitive to treatments during the disease course.