Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Health Benefit Package Revision Is an Art as Much as a Science – Lessons Learned on the Organization of the Appraisal Phase 1 6 4702 10.34172/ijhpm.8819 EN Rob Baltussen Radboud University Medical Center, Nijmegen, The Netherlands Mojtaba Nouhi Ministry of Health and Medical Education, Tehran, Iran Andrew Mirelman World Health Organisation (WHO), Geneva, Switzerland Sameen Siddiqi Aga Khan University, Karachi, Pakistan Cassandra Nemzoff London School of Hygiene & Tropical Medicine, London, UK Gavin Surgey Radboud University Medical Center, Nijmegen, The Netherlands Stella Umuhoza University of Rwanda, Kigali, Rwanda Saltanat Zhetibaeva Ministry of Health, Astana, Kyrgyzstan Baktygul Isaeva Ministry of Health, Astana, Kyrgyzstan Anna Vassal London School of Hygiene & Tropical Medicine, London, UK Journal Article 2024 09 23 <span class="fontstyle0">Many low- and middle-income countries are designing or revising their health benefit packages (HBPs), with appraisal—prioritizing services for reimbursement—being a critical phase. This occurs in a complex landscape of multiple criteria, multiple stakeholders, limited evidence, budget constraints, and tight timelines, varying across countries. Existing guidance documents do not fully address these complexities, requiring analysts to balance methodological rigor with practical constraints. This editorial highlights four key themes in organizing appraisal: decision-making structures, trade-offs between criteria, final recommendations, and the use of cost-effectiveness evidence, thresholds, and budgets. These emerged as central challenges in HBP revisions in Iran, Kyrgyzstan, Liberia, Pakistan, and Rwanda. We emphasize cross-country learning to address these challenges pragmatically, recognizing that high-quality, legitimate appraisal is as much an art as a science. More detailed documentation of appraisal processes is needed to refine HBP revision guidelines and strengthen priority-setting in health systems. </span> https://www.ijhpm.com/article_4702_e404cefd13108519c7ea3ea55e742019.pdf