The processes of policy development and implementation in the public sector are complex and
dynamic as several actors with different interests are involved. To pursue their benefits, these individual and
organizational participants compete with each other, and those with a relatively high degree of power can
lead the policy decisions. Results of and recommendations derived from economic evaluation and other forms
of health technology assessment (HTA) are expected to have an important role in policy making and professional
practice. However, it appears that on many occasions, such scientific evidence is neglected. Complex
calculations, arbitrary assumptions, debatable choices of whose perspectives to pursue, difficult-to-understand
methods, research designs and underlying philosophy/concepts, and time-consuming processes are claimed
as key factors discouraging policy makers and practitioners from making use of HTA findings. Ethical
considerations and the perception that HTA-based clinical guidelines undermine professional autonomy are
also crucial.

Keywords: Public policy, Policy process, Health technology assessment, Economic evaluation, Priority setting,
Evidence-based medicine, Ethics