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It is an opinion widely shared, at least among health economics (HE) and health technology assessment (HTA) experts, that the need for HE and HTA is increasing due to two main factors. One is the more and more serious budget constraints of the recession, the other increasingly demanding policy makers and funders who require greater evidence for new and existing therapies. But is this really the case? Are policy makers and funders aware of the potentials and limitations of HE and HTA? If they are convinced and committed to use HE and HTA results, is there sufficient capacity at national level to provide the required HE and HTA evaluations both in terms of quantity and quality? Are these methodologies and results recognised or valued during the decision making process? More than 20 years ago, in the early 1990s when the political systems in Central and Eastern European countries changed from socialism to democracy, many of us believed that HE and HTA would spread quickly around the region. We thought HE and HTA institutions and university departments would be established and that this development would be boosted further by the pure fact of EU enlargement incorporating all new member states. We had a dream that more and more resource allocation decisions related to drug reimbursement and public health would be based on results, provided nationally, from HTA and HE. At that time we had no doubt that, due to sustainable economic growth, fresh money would be allocated to different parts of health care systems under the title of ‘‘resource allocation’’. Our methodology was set to assist decisions under this economic condition. Various projects funded by the European Commission, and worldwide (INAHTA) and European networks (EunetHTA) pushed things further. However, this dream is still sluggish in coming to fruition. Still today, the role of HE and HTA is very limited in the new member states. Only two countries, Poland and Hungary, have established HTA offices and some university departments of HE. In the following, we will see what has been achieved so far, look at possible explanations for this slow development, and discuss the main issues still waiting to be resolved.

Health economics and health technology assessment in Central and Eastern Europe: a dose of reality