The State Budget of Ukraine in 2021 is 159,2 billion UAH. It is 36.8 % more than in 2020, but this amount is still insufficient to cover all the healthcare needs in Ukraine. Economic hardships, the lack of funds in the healthcare system of Ukraine, as well as COVID-19 pandemic have increased the importance of Health Technology Assessment (HTA) as a tool of cost optimization. The introduction of hospital-based HTA along with national / regional HTA allows providing the use of effective, safe and economically justified health technologies that will give our citizens the access to treatment and the rational use of funds, in particular the budget ones. Aim. To analyze the world experience of using hospital-based HTA and its main differences from national / regional HTA. Materials and methods. The scientific information of international and domestic literary sources was analyzed. The methods of content analysis, historical, system-analytical and generalization were used during the research.Results. The authors reviewed the literature in Pubmed and Google Scholar databases devoted to the international experience of hospital-based HTA and its main differences from national / regional HTA. It has been determined that the transfer of the national / regional HTA results to the hospital level is hindered by a number of differences between the country as a whole and hospitals in particular. These include, first of all, features related to demographic indicators, epidemiology of diseases, the level of resistance, local approaches to treatment, various types of equipment used in hospitals, and others. In order to have practical benefits, HTA must be built taking into account the peculiarities of a medical institution where the health technologies studied will be used in the future.Conclusions. The need of effective management of hospital resources when a number of health technologies is increasing, the desire to improve clinical outcomes, improve the quality of life and its expectancy using health technologies with the proven effectiveness and safety, the need to evaluate medical equipment and consider organizational aspects related to introduction of a health technology, as well as assess the current equipment and treatment methods require to develop the scientific and practical approaches to hospital-based HTA and recommendations on collaboration between national / regional and hospitalbased HTA in Ukraine.

The limited resources of the health care system and the COVID-19 pandemic encourage more rational and cost-effective administrative and clinical decisions. To achieve the best health care within available resources, the introduction of the most efficient technologies should be supported, considering organizational, social and ethical issues. Assessment of health technologies at different levels, namely national/regional and hospital, is becoming increasingly important. Adherence to cost-effective approaches to administrative and clinical decision-making will ensure the rational use of the state budget and improve clinical outcomes, improve the quality and life expectancy of patients. The purpose of the study was to analyze the current regulatory framework for the introduction of health technologies (medicines and medical devices) at the hospital level. During the research the methods of content analysis, historical, system-analytical, generalization was used. According to the analysis of the decision-making regulatory framework for the health technology’s introduction, it was drawn the next conclusions. The active HTA development in Ukraine is noted. In a short time, a legal framework for state HTA for medicines was created and approved, amendments were made to the Law of Ukraine ‘On Public Procurement’ and other Ukraine’s laws on medicine procurement under managed entry agreements, the further steps for development of the HTA ecosystem in Ukraine were identified. The legal framework for the circulation of medical devices needs to be updated in Ukraine, starting with technical regulations in accordance with EU regulations №745 and №746 and further approval of the Law on Medical Devices. Procedures for evaluation and selection of medicines and medical devices at the level of medical institutions are absent in Ukraine and require separate elaboration. The introduction of HB-HTA will help hospital managers to make independent, transparent, reasonable, and impartial management decisions on the selection of drugs and medical devices. The obtained results prove the need for further research of everyday decision-making practices on the introduction of health technologies at the hospitals, development of methodology for hospital-based HTA and update regulation of HB-HTA in the current legal framework of Ukraine.

Health technology assessment in the world is increasingly conducted at the hospital level, where the costs, impacts and benefits of health technology can be directly assessed in a specific hospital. One of the urgent issues is the preparation of qualified hospital staff for the implementation of hospital-based HTA. Aim. Develop and conduct the first training on hospital-based health technology assessment for hospital stakeholders of Ukraine. Materials and methods. DACEHTA (англ. Danish Centre for Evaluation and Health Technology assessment) and AdHopHTA  (англ. Adopting hospital-based Health Technology Assessment) guidelines were included into the analysis. The methods of content analysis, systematization and data generalization were used. Results. The first training on hospital-based HTA was conducted in the Regional Clinical Hospital named after O. O. Gerbachevsky of the Zhytomyr Regional Council. 9 hospital stakeholders were identified by preliminary semi-structured interview: the medical director of therapy, the medical director of surgery, the deputy director of economic, the head of the monitoring department, the representative of the information and statistics department, representatives of two clinical departments, of laboratory department and department of functional diagnostics. The curriculum was build taking into account he basic HB-HTA skills needed for hospital specialist should possess and included 8 blocks, each lasting 1.5 hours. Each block consisted of both theoretical and practical components and finished with homework, which was discussed at the beginning of the next block. This approach enabled the participants to better assimilate the presented information and carefully complete the homework of each block. Conclusions. The participants of the training noted that the use of hospital-based HTA is the most relevant issue today. Making management decisions based on HB-HTA will allow a more optimized hospital budget usage.  At the same time, the participants emphasized the importance of the work of a cross-functional team in conducting HB-HTA with the mandatory involvement of hospital economists. Based on training participants and HTA international experts feedback, a two-week post-graduated course "Hospital-based HTA is a practical tool for making scientifically based decisions at the hospital level" was developed and approved in the NMU named after O.O. Bogomolets.

Hospital-based health technology assessment (HB-HTA) is one of the components of public management and support hospital managers to science-based decision-making regarding the implementation of new and innovative health technologies (HT). HB-HTA includes the processes and methods used to make HTA reports in and for hospitals. Ukraine has already started implementing hospital-based HTA, but a number of steps are still needed to fully implement HTA at the hospitals. One of them is the choice of HB-HTA report form, which will be appropriate to use in the practical activities of hospitals in Ukraine. The purpose of the study is to analyse the international experience of using different HB-HTA report form with the aim of selecting the optimal HB-HTA report form for hospitals in Ukraine. There were analysed different forms of HTA reports in Ukraine regulatory framework, international scientific literature, the AdHopHTA handbook, which included the following countries: Norway, Finland, Turkey, Spain, Austria, Italy, Estonia, Denmark, Switzerland, in international HTA database INAHTA, Canadian and Kazakhstan report databases. The methods of content analysis, systematization and generalization were used. Making managerial decisions about investment or disinvestment in health technology requires information that meets the hospital stakeholders needs. Such scientifically based information is provided by HB-HTA report form. There are a wide range of HB-HTA reports forms in terms of content, subject matter, structure and resources (time and staff). Each is based on the EUnetHTA HTA core model. For introducing a hospital-based HTA, the countries of the world most often choose the mini-HTA form. Mini-HTA supports hospital managers to make science-based strategic decisions of the introduction of new treatment methods, new indications for the use of existing technology, medical equipment, medical devices, or stopping the usage of health technology. The choice between performing a mini-HTA or a more comprehensive hospital-based HTA often requires a balance between the quality and thoroughness and the necessary speed of assessment in a specific situation. From the authors' point of view, the most applicable to Ukrainian context is the mini-HTA form. Adapting mini-HTA and approving it as a recommended report form at the state level will provide an opportunity to more widely HTA usage by hospitals in Ukraine.