According to respondents, one of the most relevant areas where patient engagement should be more intense is HTA. Nevertheless, five of the 19 PO respondents reported limited use of HTA for policy and reimbursement decisions in their country (see Table 5). In some countries patient empowerment in HTA or policy recommendations was only superficial. In three cases POs did not contribute to final HTA recommendations or reimbursement decisions; their role was limited to participation in quality of life surveys. Three respondents who personally participated in HTA or policy discussions reported doubts whether their opinion was taken into account in the final decision.