Health technology assessment in Italy.

OBJECTIVES The aim of this study was to review the history of health technology assessment (HTA) in Italy. METHODS Founded in 1978, the Italian National Health Service (NHS) has been strongly regionalized mainly after a constitutional reform, which started a devolution process. HTA started in the 1980s at the National Institute of Health and in a few University Hospitals, with a focus on big ticket technology: that process was driven by clinical engineers. RESULTS In recent years, HTA is becoming an important tool for decision-making processes at central, regional, and local levels. In particular, the National Agency for Regional Health Services (AGENAS) and five regions (of twenty-one) are strongly committed to develop HTA initiatives connected with the planning process. CONCLUSIONS At the local level, the hospital-based HTA activity is probably the most important peculiarity of the country and the real driver of the HTA movement.