A regulatory governance perspective on health technology assessment (HTA) in France: The contextual mediation of common functional pressures

Highlights • Applies a new regulatory governance frame to the study of health technology assessment (HTA). • HTA does not take place within isolated institutions that apply self-selected methods. • Development of national HTA agencies follows an evolutionary pattern under which contextual factors mediate common functional pressures. • European calls for harmonization of HTA methods are likely to be met with diverse national policy responses. • French process for HTA uses multiple stakeholders to contain costs within the system. • French policy makers have been historically wary of strict economic measures of cost-effectiveness.