Best-worst scaling to assess the most important barriers and facilitators for the use of health technology assessment in Austria

Background: Although Health Technology Assessment (HTA) is increasingly used to support evidence-based decision-making in health care, several barriers and facilitators for the use of HTA have been identified. This best-worst scaling (BWS) study aims to assess the relative importance of selected barriers and facilitators of the uptake of HTA studies in Austria.Methods: A BWS object case survey was conducted among 37 experts in Austria to assess the relative importance of HTA barriers and facilitators. Hierarchical Bayes estimation was applied, with the best-worst count analysis as sensitivity analysis. Subgroup analyses were also performed on professional role and HTA experience.Results: The most important barriers were lack of transparency in the decision-making process', fragmentation', absence of appropriate incentives', no explicit framework for decision-making process', and insufficient legal support'. The most important facilitators were transparency in the decision-making process', availability of relevant HTA research for policy makers', availability of explicit framework for decision-making process', sufficient legal support', and appropriate incentives'.Conclusion: This study suggests that HTA barriers and facilitators related to the context of decision makers, especially policy characteristics' and organization and resources' are the most important in Austria. A transparent and participatory decision-making process could improve the adoption of HTA evidence.