AUTHOR=Zhou Na , Ji Hong , Li Zheng , Hu Jun , Xie Jia-Hua , Feng Yu-Heng , Yuan Ni TITLE=Influencing Factors of Health Technology Assessment to Orphan Drugs: Empirical Evidence in England, Scotland, Canada, and Australia JOURNAL=Frontiers in Public Health VOLUME=Volume 10 - 2022 YEAR=2022 URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.861067 DOI=10.3389/fpubh.2022.861067 ISSN=2296-2565 ABSTRACT=Objective: To summarize the intrinsic criteria for the recommendation of rare drugs in the four countries, to try to understand the rationale for the variability in decision-making, and to provide a reference for the establishment of criteria in the process of access to health insurance for rare drugs in different countries and the construction of national uniform criteria. Method:A comparative analysis of 60 HTA guidances of 15 drug-indication pairs appraised by four countries (England, Scotland, Canada, and Australia) from 2017 to 2018, including an in-depth analysis of a case study. Agreement levels were measured using kappa scores. Associations were explored through correspondence analysis. Results: The four countries possess some homogeneity in the assessment, but each has its own preferences. Poor agreement exists between England, Scotland and Canada (-0.410