ISPOR’s Laura Pizzi and Mitch Higashi on the 2026–2027 Top 10 HEOR Trends and their implications for evidence and access

As global health systems face rising complexity, ISPOR’s 2026–2027 Top 10 HEOR Trends report offers a timely snapshot of what ISPOR—The Professional Society for Health Economics and Outcomes Research, and the wider HEOR community, view as the most critical priorities for the next 2 years. From the rapid ascent of AI to the evolving roles of real-world evidence (RWE), health technology assessment (HTA), and value-based healthcare (VBHC), as well as broader concepts of value such as whole health, the trends capture both momentum and scrutiny in how evidence is generated, assessed, and used.

In this interview, we speak with ISPOR’s Dr Laura Pizzi (Chief Science Officer) and Dr Mitch Higashi (Associate Chief Science Officer) to explore the thinking behind the trends and what they signal for researchers, payers, policymakers, and patients, including the opportunities, tensions, and unanswered questions likely to shape HEOR in the future.

Congratulations on the latest Trends Report, which offers a useful snapshot of where HEOR is heading. Can you walk us through the methodology used to select and prioritize the 2026–2027 Top 10 Trends, and how input from stakeholders and global thought leaders shaped the final rankings?

Thanks for inviting us to talk about our latest trends report. Published every 2 years, the Top 10 HEOR Trends are identified by a survey of ISPOR members around the world, primarily HEOR professionals working in different settings (industry, academia, etc.) alongside a small number of other stakeholders such as patient representatives, HTA authorities, and regulators.

We inform the topics included in the survey by examining the trends from the last report and asking for input from our Health Science Policy Council to suggest new topics. This council is ISPOR’s most senior group of HEOR thought leaders. We then field the survey to our members through direct outreach. Then, once the results are available, we take a critical look at the Top 10 and develop a short report that reflects on why those rose to the top and what key developments in that space are.

AI moved up to #1. In your view, what has changed most since the last edition to drive that rise?

AI moved from a new buzzword in 2023 to a dominant methodological theme by 2025. Researchers presenting their projects at ISPOR conferences have evolved from “Can AI do this?” to a reportable scientific practice for key HEOR workflows:

• Full pipelines for systematic literature reviews (screening, extraction, tagging, analysis)
• Generative AI to build or adapt economic models
• AI in HTA submissions

ISPOR is now offering short courses dedicated to GenAI and LLM workflow integration (e.g., Introduction to Applied Generative AI for HEOR).

The ISPOR Working Group in Generative AI produced three papers to begin developing formal AI governance frameworks, including:

1. ELEVATE‑GenAI reporting guidelines for all HEOR work involving LLMs
2. Taxonomy of Generative AI in HEOR and structured classification of models, use cases, risks, and reliability issues
3. Generative AI for HTA: A dedicated ISPOR working group defining opportunities and policy implications for HTA bodies

RWE now ranks #2, with the report emphasizing transparency, harmonized protocols, and data availability. What advances or challenges do you expect next to strengthen the rigor and reproducibility of RWE?

RWE and AI are naturally linked, so while they appear separate on the trends list, we increasingly need to think about them together. AI is now powering design and analysis of RWE studies: it can draft protocols using templates such as HARPER; it can inform design choices; it can assess data quality; it can harvest qualitative text from electronic health records; it can inform bias assessment – and the list goes on. The next phase of this movement will not only include further experimentation of these applications but also, and critically, involve developing approaches to measure their validity. The latter is absolutely essential to ensuring a level of rigor that is acceptable to decision-makers such as regulators and HTA authorities.

“The future for RWE is incredibly exciting as the number of datasets available for research increase globally, policymakers continue to take interest in supporting the use of real-world data (RWD), and we move towards increased standardization of the field.”

In terms of reproducibility, this is an issue that is not limited to RWE but in fact all types of scientific research – even clinical trials. What we anticipate is a growing expectation that protocols must be prespecified using an open registry like the one available through ISPOR and at the time of results reporting, detailed methods, statistical code, or even the data itself may be required. All of this amounts to increased transparency. This past year, we implemented Center for Open Science badges for RWE studies published in our journals Value in Health and Value in Health Regional Issues. These badges exemplify the types of “stamps of approval” that submitters to our journals can now declare, and by so doing, readers of those articles can freely search and obtain more details about them. ISPOR is incredibly proud of the relationship it has with other major RWE-focused professional organizations like the International Society for Pharmacoepidemiology (ISPE). We work together to advance RWE through collaboration.

Value-based healthcare debuts at #3. What global pressures are driving its growing prominence, and how can HEOR best support successful implementation of VBHC?

A persistent healthcare labor shortage, declining health system productivity, and patient challenges with healthcare affordability have been consistent long-term trends in favor of VBHC. However, over the past decade, three major shifts have enabled value based healthcare to rise as a top global trend:

1. The maturation of data, analytics, and AI infrastructure, which replaced the immature digital capabilities that once prevented scalable outcome measurement and made it possible for health systems to reliably link costs to outcomes
2. The emergence of strong global policy momentum, with governments, WHO, OECD, and national health agencies now actively promoting value-based financing and outcome accountability after years of limited policy support
3. A significant rise in provider, payer, and market readiness, as hospitals, insurers, and health systems are now investing in outcome benchmarking, bundled payments, and value-driven operational models, reversing the low readiness that held VBHC back in 2016

These three enablers – digital maturity, policy alignment, and market adoption – have transformed VBHC from an aspirational concept into a globally scalable health system reform strategy.

Drug pricing remains a top global issue. What do recent US policy changes signal about the future direction of pricing and reimbursement, and what role should HEOR play in shaping the next stage?

Beginning with the Inflation Reduction Act (IRA), which for the first time gave the US federal government authority to directly negotiate drug prices with manufacturers, the policy environment has rapidly evolved through a series of mandatory CMMI demonstration models, including GENEROUS (a voluntary Medicaid most-favored-nation [MFN] framework) and the mandatory GLOBE (Part B) and GUARD (Part D) MFN‑based pricing models that tie US reimbursement levels to international reference prices and require rebates when domestic prices exceed those paid in peer nations. These models collectively push manufacturers toward globally benchmarked pricing by replacing traditional ASP‑based formulas with international reference pricing and MFN‑anchored rebate obligations, thereby reinforcing the shift toward international prices across federal programs.

This has triggered a growing interest in how global HTA bodies, from Europe to Asia‑Pacific, set their own reference prices, evaluate comparative effectiveness, and use international benchmarks to guide reimbursement, creating a world in which drug developers face emerging global policy convergence around value, evidence, and internationally aligned pricing norms. In the US, we expect to see strong advocacy from the HEOR community for CMS to begin incorporating value metrics into these pricing recommendations: outcomes, comparative effectiveness, or patient‑centered value.

‘Relevance of HEOR’ is a new entry. What drove its inclusion this year?

A confluence of factors is driving this. First, major government policies pertaining to the pricing of innovation (e.g., IRA, MFN) and HTA collaboration (e.g., Joint Clinical Assessment [JCA] in Europe) have fueled the need for HEOR evidence. Second, there have been major organizational changes in large biopharmaceutical companies which have reshaped where and how HEOR is conducted. While some companies have retained a centralized “HEOR department” model, many have shifted it to medical affairs, market access, and/or RWE departments. This presents an enormous opportunity but also a challenge in terms of coordinating evidence development.

Another driver of the “Relevance of HEOR” is the entry of early-stage biotech and healthcare investors into the HEOR sphere. These entities realize that the evidence required to get you to market is not limited to clinical trials but also includes HTA and payer analyses, which are the mainstay of HEOR.

HTA and value measurement have re-emerged as key trends. What factors are driving their continued prominence?

HTA as a function has grown worldwide. We estimate that around 100 countries now have some HTA function, albeit that may be nascent in emerging countries. This signals that countries understand the need to systematically assess which health-improving innovations have value and for which patients. The HTA trend is specifically about collaboration across HTA which we see happening in a variety of ways: in the EU through JCA; in Canada, US and UK through the Health Economics Methods Advisory (HEMA); in Asia-Pacific through shared learnings and experiences via HTAsiaLink. These are just a few visible examples but these types of HTA interactions between countries are happening organically every day.

For these collaborations to work, there needs to be increased transparency with assessments. While some HTA bodies make their assessments public, others do not – or release partial information. All of this said, it’s unlikely we will achieve a single “global evidence template” as a result of these collaborations, because evidence requirements are importantly shaped by countries’ social and economic priorities.

As for value measurement, we continue to see interest from HTA, payers, and patient representatives on expanded value measures. The reality is that HEOR hasn’t done a great job at bringing expanded measures into our assessments; for example, despite there being established measures for productivity and caregiver impacts, those haven’t routinely been included in HEOR assessments for a number of reasons – lack of data, lack of relevance to the stakeholder making the decision, lack of relevance to the intervention being studied.

With the proliferation of RWD sources and increased recognition of benefit measures outside of health itself, this trend will continue. It does, however, challenge HTA norms in some countries, particularly those where traditional cost-effectiveness analyses have been a main driver of decisions. Multi-criteria decision analysis is a tool that can be used to evaluate extended measures, but important methodological issues remain such as how to account for cross-sector benefits and costs and from whose perspective such analyses would be relevant.

The perspectives most interested in these analyses aren’t likely to be limited to healthcare decision-makers, but also social service decision-makers, ministries of health, and finance ministries.

“HEOR analyses of today are focused on healthcare payers; HEOR analyses of tomorrow will be focused on healthcare payers and extended stakeholders – with those determined by the intervention being assessed as well as the local decision-making context.”

This is a paradigm shift in global evidence that is a main priority for ISPOR and relates to our strategic commitment to our Whole Health Initiative.

Across the Top 10, which shift do you think will have the greatest impact on evidence generation and decision-making over the next 2 years, and why?

Drug pricing, ranked #4 in the report, will likely exert the greatest global impact on practicing HEOR professionals over the next 2 years because it sits at the intersection of rapidly evolving policy, affordability pressures, and expanding evidence expectations.

“As countries confront escalating costs driven by novel therapies and increasing demand, drug pricing reform is becoming a central policy lever to ensure sustainability and access, a trend explicitly highlighted in ISPOR’s identification of drug pricing as a recurring, high priority global issue.”

For HEOR professionals, this means intensified demand for rigorous economic modeling, RWE frameworks, and value-based assessments to inform pricing negotiations, international reference pricing systems, and cost-effectiveness standards – areas increasingly shaped by global policy shifts.

The prominence of drug pricing in the Top Trends report also reflects how it amplifies nearly every other trend – from AI-enabled analytics to the globalization of HTA – creating a multiplier effect on HEOR workloads, methods, and stakeholder expectations.

A new feature of drug pricing is the emerging pharmaceutical manufacturing reshoring wave. This adds a new geopolitical dimension to pricing policy. Governments may increasingly use reshoring commitments as leverage in pricing negotiations, while industry may position domestic investment as a counterweight against deeper price controls. This evolving dynamic means HEOR professionals will need to account for industrial/policy incentives and supply chain restructuring as part of future drug pricing analyses.

Expanded measures of value, ranked #9 in the list, will likely exert the greatest impact on HEOR methodologists and HTA authorities for reasons we discussed previously.

Looking ahead, which trend(s) on the Top 10 do you think will look most different by 2028, and what early signals should we be watching for?

AI, specifically agentic AI, is poised to look the most different by 2028 because it is evolving from a decision‑support technology into an autonomous, goal‑directed system capable of orchestrating complex analytical workflows, synthesizing RWE, and dynamically interacting with datasets and stakeholders. Our Top 10 HEOR Trends report already places AI as the #1 trend, emphasizing its rapid transformation of healthcare and HEOR and the growing need for responsible implementation frameworks.

Agentic AI represents the next inflection point: systems that can initiate actions, refine their own outputs, and coordinate multi‑step evaluations could dramatically alter evidence generation, modeling, and HTA processes. Early signals to watch include AI tools capable of autonomous evidence synthesis, rapid-cycle cost‑effectiveness modeling, and continuous RWE signal detection – capabilities that will pressure existing methodological standards to evolve.

“As adoption of these systems increases, the “human at the helm” principle becomes essential. HEOR professionals must ensure that human judgment, ethical safeguards, and transparent scientific methods remain central as AI grows more capable. This human‑guided governance will be the key determinant of whether agentic AI amplifies rigor and equity, or introduces risks that undermine trust and scientific integrity.”

Interviewees 

Laura T. Pizzi, PharmD, MPH
Chief Science Officer, ISPOR

Dr Laura Pizzi is the Chief Science Officer for ISPOR, the leading global professional society for health economics and outcomes research (HEOR.) In this role, she provides strategic scientific leadership, overseeing the organization’s major initiatives, including the development of ISPOR’s science strategy, content priorities, and global initiatives such as Special Interest Groups, the Patient Council, regional Patient Representative Roundtables, and the organization’s Digital Health Strategy. Dr Pizzi co-leads the development of the ISPOR Health Economics and Outcomes Research Competency Framework, which outlines the core knowledge and skills essential to the HEOR profession.

Dr Pizzi brings more than 20 years of academic and research expertise to ISPOR. She has led interdisciplinary teams of methodologists, statisticians, and clinicians in designing and conducting cost and outcomes analyses for both pharmacologic therapies and non-pharmacologic interventions. Much of her work has focused on improving the quality of care for older adults through the US translation and implementation of cost-effective interventions. Her achievements include leading health economic analyses for numerous multicenter clinical trials, testifying before the US House of Representatives Committee on Ways and Means on Medicare overspending, authoring a textbook on economic evaluation, and publishing more than 100 peer-reviewed manuscripts and 120 research presentations.

In addition to her leadership role at ISPOR, Dr Pizzi serves as Research Professor at Rutgers University, holding faculty appointments at the Ernest Mario School of Pharmacy and Rutgers School of Public Health. Her academic career has centered on advancing the science of health economics, influencing healthcare policy, and training the next generation of HEOR professionals.

Mitch Higashi
Associate Chief Science Officer, ISPOR

Mitch Higashi is the Associate Chief Science Officer of ISPOR’s leadership team. Dr Higashi contributes to the development and deployment of ISPOR’s science and content strategies, and collaborates with members, groups, stakeholders, and staff to advance initiatives that increase awareness, understanding, and application of HEOR around the world. Prior to ISPOR, Dr Higashi served as Vice President, HEOR at Bristol-Myers Squibb, and has worked in related roles at GE Healthcare and GlaxoSmithKline. Dr Higashi earned his PhD in health economics and outcomes research at the University of Washington.

Disclaimer 

The opinions expressed in this feature are those of the author and do not necessarily reflect the views of The Evidence Base® or Becaris Publishing Ltd.