ACR 2025: Dr. Sabine Grimm explains why HTA is vital for advancing rheumatology access and equity

Health technology assessment (HTA) is increasingly being recognized as a core enabler of responsible innovation and sustainable healthcare delivery, especially in complex fields like rheumatology. That was the message delivered by Dr. Sabine Grimm, Senior Researcher at Maastricht University Medical Center, during her keynote presentation at the Global Rheumatology Summit, held October 24, 2025. The session, which opened the pre-conference day for ACR Convergence 2025, drew attention to how HTA can help bridge the growing divide between medical breakthroughs and equitable patient access.

Dr. Grimm’s keynote, titled “Health Technology Assessment in Rheumatology: Why It Matters, How It Works, and Where It’s Going,” made a compelling case for why HTA must evolve alongside medical innovation. She described HTA as a multidisciplinary process that evaluates the value of health interventions—not just their efficacy or safety, but their ability to deliver real-world impact in a financially sustainable way. With biologics, precision diagnostics, and digital tools expanding rapidly across rheumatology, decision-makers require robust frameworks to determine what works, for whom, and at what cost.

How does HTA help manage healthcare spending while prioritizing patient outcomes?

At the heart of Dr. Grimm’s presentation was the growing pressure on health systems to deliver more with less. She highlighted that rising healthcare costs are increasingly leading to displaced spending in other sectors, raising long-term sustainability concerns. In this environment, HTA becomes a mechanism to ensure that limited resources are directed toward interventions with the greatest value for patients and society.

Dr. Grimm described HTA as a tool to support evidence-based choices—not to restrict innovation, but to channel it more effectively. By identifying treatments that offer the best trade-off between clinical benefit and cost, HTA frameworks help payers and providers avoid wasteful spending and instead focus on high-impact therapies. She emphasized that HTA works best when it accounts for the complexity of chronic disease management, not just single interventions.

Importantly, Dr. Grimm called for a shift in how value is defined. Rather than focusing narrowly on clinical trial endpoints, she advocated for an approach that includes patient-reported outcomes, quality of life improvements, and broader societal impacts such as work productivity and caregiving burden.

What do real-world HTA case studies in rheumatology reveal about current challenges?

To illustrate both the promise and complexity of HTA, Dr. Grimm presented three case studies that have influenced HTA policy discussions: the National Institute for Health and Care Excellence (NICE) appraisal in rheumatoid arthritis, the reassessment of belimumab in systemic lupus erythematosus (SLE), and a diagnostic evaluation for axial spondyloarthritis.

In the NICE example, a major limitation was the absence of real-world data to confirm whether the benefits seen in controlled trials were being replicated in clinical practice. This limited the agency’s ability to make confident reimbursement decisions. According to Dr. Grimm, better integration of real-world evidence could strengthen these evaluations.

In contrast, the belimumab assessment incorporated real-world data, but still ran into issues. Because SLE is a chronic condition with variable disease activity, short-term datasets failed to capture long-term treatment effects. This misalignment between trial duration and disease dynamics introduced uncertainty into the HTA process.

In the case of axial spondyloarthritis, Dr. Grimm discussed the challenge of applying complex diagnostic algorithms in different healthcare systems. Many HTA frameworks assume a high level of diagnostic infrastructure, but this is not always feasible in low-resource settings. She stressed the need for adaptable models that reflect local capacity and real-world clinical workflows.

These examples revealed that HTA must evolve beyond static reviews of published trial data. Instead, flexible, context-aware approaches are needed to ensure that the assessment process remains relevant and responsive.

Why is adaptive HTA gaining traction as a solution for resource-constrained environments?

One of the key innovations Dr. Grimm advocated for is adaptive HTA—a more flexible and iterative approach to assessment that adjusts based on available evidence, urgency of need, and local resource availability. Rather than requiring a complete data package before initiating an assessment, adaptive HTA allows decision-makers to work with partial data while planning for future updates.

In the Netherlands, Dr. Grimm noted, HTA reviews are often conducted by external academic groups and can take several months to complete. While this allows for depth and rigor, it is not always practical—especially in countries with limited analytic capacity or high disease burden. Adaptive HTA can reduce delays, support interim decision-making, and help systems prepare for scale-up as more data becomes available.

Stakeholder engagement was also emphasized as a key enabler of effective HTA. Dr. Grimm stressed the importance of involving clinicians, patients, policymakers, and health economists early in the process. Without input from those directly affected by a condition or treatment, HTA risks missing critical contextual factors. In particular, patient-reported data and clinical judgment should be used to supplement statistical models.

What macro trends will reshape HTA frameworks in the coming years?

Looking forward, Dr. Grimm identified three overarching trends that she believes will redefine HTA in rheumatology and beyond: personalized medicine, digital health, and international harmonization of regulatory processes.

As medicine becomes more personalized, HTA frameworks must evolve to assess value not just at the population level, but for specific patient subgroups. Rheumatology is already seeing a shift toward biomarker-guided treatments and precision dosing, which complicates traditional cost-effectiveness models. Dr. Grimm suggested that adaptive trial designs and real-time registries will be key to generating the evidence needed for subgroup-specific HTA.

Digital health was another major theme. From symptom tracking apps to wearable data, patients are increasingly generating their own health data outside the clinic. Dr. Grimm emphasized that this continuous, patient-driven data can enhance the HTA process by providing real-world insights into treatment adherence, symptom variability, and daily functioning. However, she also cautioned that digital inclusion must be ensured so that data collection does not inadvertently exclude underserved populations.

Finally, global harmonization emerged as a critical need. HTA duplication across countries delays access and wastes resources. Dr. Grimm advocated for greater regulatory alignment, especially across Europe, so that evidence generated in one jurisdiction can be leveraged elsewhere. Joint assessment models and shared evidence platforms could accelerate access while maintaining local autonomy.

How should rheumatologists and policy stakeholders respond to this evolution?

Dr. Grimm concluded her presentation with a call to action. She urged rheumatologists, researchers, and health system leaders to embrace HTA not as a gatekeeping function, but as a collaborative tool for informed decision-making. She encouraged clinicians to contribute their expertise to assessment frameworks and to advocate for inclusion of data that reflects clinical nuance and patient reality.

She also reminded policymakers that the goal of HTA is not merely to say “yes” or “no” to a technology, but to guide its use in a way that maximizes patient benefit and system sustainability. In an era of financial constraints and medical complexity, HTA can offer a principled path forward—if it is designed with transparency, inclusivity, and adaptability in mind.

With HTA becoming more integrated into clinical decision-making, especially in specialized fields like rheumatology, its influence on reimbursement, clinical guidelines, and research funding is only set to grow. For stakeholders across the health ecosystem, staying engaged with HTA processes will be critical to ensuring that the future of care remains both innovative and equitable.

Key takeaways: What did Dr. Sabine Grimm’s ACR 2025 keynote reveal about the role of HTA in rheumatology?

• Dr. Sabine Grimm, Senior Researcher at Maastricht University Medical Center, delivered the ACR 2025 Global Rheumatology Summit keynote on the future of health technology assessment (HTA) in rheumatology.
• She emphasized HTA as a multidisciplinary tool that evaluates not only clinical efficacy but long-term value, access, and sustainability for rheumatic disease treatments.
• Rising healthcare costs and limited resources make HTA essential for prioritizing high-impact therapies and managing system-wide affordability.
• Three case studies were discussed: a NICE rheumatoid arthritis appraisal, a reassessment of belimumab in systemic lupus erythematosus (SLE), and evaluation of axial spondyloarthritis diagnostic tools.
• Dr. Grimm called for more real-world evidence (RWE) and adaptive HTA models to improve speed and local applicability, especially in resource-constrained healthcare systems.
• She outlined three key trends shaping the future of HTA in rheumatology: personalized medicine, digital health integration, and global harmonization of regulatory assessments.
• Stakeholder engagement—including clinicians, patients, and policymakers—was identified as critical to ensuring HTA frameworks reflect real-world care environments.
• The keynote urged clinicians to contribute actively to HTA frameworks to ensure assessments translate clinical insight into equitable patient outcomes.