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Abstract Czechia’s strategy for health names patient involvement as a goal in all areas. As a result, the reimbursement process for orphan medicinal products (OMPs) was the first area of health technology assessment (HTA) to formally introduce patient involvement in Czechia. This was enacted through national legislation that was developed and drafted with extensive input from patient representatives after an intensive training programme to build their capacity in HTA and different patient involvement approaches. This ensured that the patient involvement approaches put into law were meaningful and feasible in Czechia. The OMP legislation outlines how relevant patient organisation(s) can provide formal input to an HTA, comment on the assessment report and appeal against the final decision. Furthermore, it indicates that the panel appraising each OMP must include representatives of patient organisations and stipulates the criteria that patient organisations must fulfil to be considered eligible for participation. This chapter reflects on the processes used to support patient participation in HTA of OMPs and areas that have been challenging, to create considerations for the future as extension of patient involvement in HTA to other health technologies is considered.