An integrative model for health technology assessment: perspectives for the Russian healthcare system

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Abstract

Introduction. This article presents the Expanded Cost-Benefit Analysis (ECBA) model as an integrative approach to health technology assessment, taking into account clinical, economic, institutional, behavioral, and social factors.Purpose. To develop and justify a comprehensive model for evaluating health technologies based on ECBA, incorporating the manageability of implementation, behavioral variability, and institutional constraints.Materials and methods. The ECBA model comprises four blocks: medical outcomes, socio-demographic benefits, implementation costs, and institutional risks. Over a 10-year horizon with an 18.8% discount rate, it integrates real-world data, shadow-cost estimates, national standards (e.g., GOST R 57525–2017), and a case study on preventive ART in a metropolitan setting. Implementation feasibility is assessed via the Technology Manageability Index (TMI).Results. The ECBA model enables structured comparison of health interventions based on clinical, economic, institutional, behavioral, and social criteria. Though illustrated with the ART case, it is applicable to various preventive, therapeutic, and digital interventions in resource-limited, centralized systems.Research limitations. The model assumes stable parameters over time and uniformity of institutional and behavioral responses. It does not fully account for partial adoption scenarios, regional disparities in healthcare infrastructure, or variability in institutional implementation practices.Conclusion. ECBA supports policymakers by integrating multidimensional evidence into a unified framework, improving the assessment of health technologies’ real-world viability under regulatory, fiscal, and institutional constraints. Compliance with ethical standards. The study was approved by the local ethics committee of the Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, Moscow, protocol dated 02.11.2025 No. 02-01/ЭК/2025.Funding. This article was prepared within the framework of the research work «Development of methodological approaches to value-oriented healthcare (VOH) in the city of Moscow».Conflict of interest. The authors declare no conflict of interest.Received: March 28, 2025 / Accepted: June 24, 2025 / Published: October 31, 2025

About the authors

Anton A. Nikolaev

M.V. Lomonosov Moscow State University; Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department; National Research University Higher School of Economics

Email: nikolaevaa@my.msu.ru
ORCID iD: 0009-0004-5544-3594

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