Abu Dhabi is taking important steps to strengthen the use of HTA in healthcare decision-making, with the publication of its HTA guidelines in 2025 marking an important milestone.
The health system in the UAE
The United Arab Emirates (UAE) is a federation of seven emirate states. Accordingly, healthcare governance operates under a hybrid model, with responsibilities shared between the federal and emirate-level authorities.
At the federal level, the Emirates Drug Establishment (EDE and previously the Ministry of Health and Prevention) is the primary authority responsible for setting national health agendas, legislation, and strategies, ensuring the consistent implementation of health policies and provision of high-quality services. It is the authority responsible for medical product registration and pricing.
At the emirate level, individual emirates are responsible for resource allocation and healthcare delivery and coverage. Abu Dhabi and Dubai have established independent health authorities for regulating healthcare services and technologies. The remaining five northern emirates are overseen by Emirates Health Services (EHS), which operates under EDE guidance.
As a strong launch market for healthcare innovation, the UAE has seen a steady growth in healthcare expenditure in recent years, with a significant proportion associated with pharmaceutical spending. Recent estimates suggest that the country spends approximately 4.6% of its GDP on healthcare.
While adoption of health technology assessment (HTA) across the UAE remains at a relatively nascent stage, its processes are rapidly evolving. Demographic changes, national innovation agendas, and the emergence of high-cost therapies are likely to increase the importance of HTA in supporting healthcare sustainability and value-based decision-making.
In this issue of the Around the World in HTAs series, the focus is on Abu Dhabi, the UAE’s capital, exploring recent progress by the Department of Health (DoH) to advance HTA for healthcare decision-making.
A roadmap for new technologies
For a health technology to obtain coverage and reimbursement within the emirate of Abu Dhabi, it must first receive regulatory approval from the Emirates Drug Establishment (EDE) at the federal level, followed by approval from the DoH. Early HTA advice can also be sought via the pre-evaluation pathway for non-approved products, where DOH will guide manufacturers on the HTA application process and their eligibility. HTA appraisal is mandatory for branded pharmaceuticals, advanced therapy medicinal product (ATMP), and technologies meeting the following criteria:
- Previously approved pharmaceuticals used in new settings (e.g., indication, patient population), or new dosage forms or formulations
- New dosage forms that are considered innovative
- High-cost technologies with:
- Estimated annual budget impact > AED 10 million (US$ 2.7 million); or
- Estimated annual budget impact > AED 100,000 (US$ 27,230) per patient.
The formalisation of this pathway through the DoH’s first published HTA Guidelines in 2025 marks a pivotal moment, positioning Abu Dhabi among the first jurisdictions in the region to apply an explicit cost-effectiveness threshold (CET) within its HTA framework.
The health technology assessment (HTA) process
HTA in Abu Dhabi involves a two-step process:
- Clinical Assessment (market entry approval) conducted by the Health Life Science Sector of the DoH, which evaluates the technical characteristics of the technology and its relative clinical effectiveness and safety compared with standard of care. The clinical added benefits are evaluated via scoping and systematic reviews where critical appraisal of literature is performed.
- Economic assessment conducted by the Healthcare Payer’s and Financial Affairs Sector, primarily used to inform coverage and reimbursement decisions. For economic assessments, cost-effectiveness and budget impact analyses are mandatory. Burden of disease studies may be requested, and equity-related analyses may be required where access considerations are relevant (e.g., rare diseases, geographical disparities, and socio-economic inequalities).
To determine whether a technology provides value for money, the DoH adopts a baseline CET of 0.75 times the GDP per capita[1], which may be adjusted based on societal priorities. Adjustments are informed by three key factors: (1) disease severity, measured using proportional shortfall (PS); (2) relative health gain (RHG); and (3) disease rarity. Modifiers applied to the CET for Factors 1 and 2 are summarised in Table 1.
Table 1. Modifiers applied to the CET, based on disease severity and relative health gain.
| Band | Proportional shortfall | Relative health gain | Multiplier applied to CET (Factors 1 and 2 only) |
| Minimal | 0 | 0 | 1.0 |
| Low | 0.25 | 0.25 | 1.25 |
| Moderate | 0.50 | 0.50 | 1.5 |
| High | 0.75 | 0.75 | 1.75 |
| Very high | 1.00 | 1.00 | 2.0 (maximum) |
Proportional shortall (PS) quantifies disease severity by estimating the proportion of remaining lifetime health (in quality-adjusted life years, QALYs) lost due to a condition, relative to a healthy individual.
Relative health gain (RHG) quantifies health benefit of an intervention by estimating the incremental QALYs gained compared with standard of care.
For disease rarity adjustment (Factor 3), diseases classified as rare by the EMA or FDA are eligible for up to a 3.0x multiplier, and ultra-rare diseases are subject to case-by-case multiplier determination.
The CET is calculated by applying these modifiers multiplicatively to the baseline threshold:
CET = 0.75 × GDP per capita × (1 + PS) × (1 + RHG) × (1 + 2 × is_rare)
This multi-factor, multiplicative threshold design allowed for a more nuanced approach to appraisal than the fixed thresholds used at HTA systems in established European systems, reflecting Abu Dhabi’s deliberate choice to build additional considerations into its framework from day one.
Following HTA appraisal, technologies that receive positive recommendations are listed on Shafafiya, a health information exchange and standardisation platform that supports implementation of coverage decisions. A positive HTA decision provides coverage within government-funded programmes (i.e., public insurance) but does not automatically guarantee reimbursement by (private) healthcare providers, which may be subject to separate price negotiations. For more details on the assessment process, please consult the DoH HTA guidelines.
Building for long-term HTA maturity
Investing in local HTA capacity and capability: The DoH has made deliberate investments in building HTA expertise domestically, including international collaborations and academic partnerships. Sustained expansion of this capacity – through training programs, workforce development and institutional infrastructure – will enable the volume and complexity of appraisals to grow in line with Abu Dhabi’s healthcare ambitions.
Managing stakeholder expectations: The introduction of HTA represents a shift from a predominantly regulatory-driven market access pathway to one requiring demonstration of value for money. Manufacturers are being actively supported to navigate new evidence requirements accordingly. Additional methodological guidance, standardised submission templates, and scientific advice mechanisms will be instrumental to support evidence generation that align with DoH-specific decision-making criteria.
Embedding HTA as a value-based decision-making tool: HTA is still a relatively new discipline across the Gulf region. Broadening understanding of HTA as a framework for maximising population health and clinical benefit, not merely for managing costs, will be central to its long-term success. Abu Dhabi’s transparent, published methodology is itself a key step in this direction, demonstrating that HTA decisions are structured, equitable and evidence driven.
Next steps for HTA in the UAE
The development of HTA in Abu Dhabi is progressing rapidly, with clear ambition to expand its role in healthcare decision-making. Several priorities are likely to shape its future evolution.
Broadening the scope and application of HTA. HTA is currently focused primarily on newly launched branded pharmaceuticals and advanced therapy medicinal products (ATMPs), but its application is likely to broaden to encompass a wider range of complex interventions, including digital health and artificial intelligence technologies. In addition to informing initial coverage decisions, HTA may increasingly be used for reassessment and disinvestment, supporting more dynamic and efficient allocation of healthcare resources.
Strengthening methodological frameworks and transparency. The publication of the DoH’s first HTA guidelines represents an important milestone. However, further methodological refinement will be required as the system matures. This may include guidance tailored to different technology types, improved approaches to handling uncertainty, and potential incorporation of broader value elements. Enhancing transparency in decision-making criteria will be critical to building stakeholder trust and ensuring consistency.
Embedding lifecycle and “living HTA” approaches. Abu Dhabi’s advanced digital infrastructure positions it well to adopt lifecycle HTA approaches. Integration of real-world evidence (RWE) and data analytics could enable continuous reassessment of technologies as new evidence emerges, moving towards a “living HTA” model. This would support adaptive decision-making, reduce uncertainty at launch, and ensure that reimbursement decisions remain aligned with real-world clinical and economic outcomes.
Developing a coordinated national HTA ecosystem. While Abu Dhabi is leading HTA development, the UAE currently lacks a unified national framework. Greater alignment between emirates could facilitate knowledge sharing, reduce duplication, and improve consistency in decision-making. In the longer term, this may evolve into a coordinated or federal HTA system that accommodates emirate-specific priorities while benefiting from shared standards and infrastructure.Abu Dhabi has not simply adopted HTA – it has engineered a framework tailored to the realities of a rapidly evolving health system with world-class digital infrastructure and a genuine commitment to equitable, evidence-based care. As this system matures, Abu Dhabi is poised to become the reference model for HTA across the Middle East and beyond: a proof of concept that value-based healthcare decision-making is not just achievable in the Gulf – it is already here.
[1] At the time of writing, Abu Dhabi’s GDP per capita was estimated at approximately US$74,400 in 2025. Accordingly, baseline CET of 0.75× GDP per capita corresponds to approximately US$55,800 per QALY gained.
