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This manuscript tackles the subject of Health Technology Assessment (HTA). Technological evaluation represents a strategic function for a cost-effective healthcare; this requests a wide range of considerations to be made in terms of performance management, which involve the decision-making process on investment choices. Accordingly, both the correct exploitation of resources and the control of the costs related to the production of healthcare seem to be the principal mainstays which allow such services to satisfy specific patients' needs.Particularly, HTA performed within the hospital sphere (Hospital-Based HTA) strongly affects the managerial field and it is strictly related to the strategic planning and controlling of Health Institutions. Thus, a holistic approach to the management of healthcare organizations is required along the whole pathway of performance definition and its development. The framework developed in this work, the Health Technology Balanced Assessment (HTBA), contributes to foster an evaluation process aimed at discovering, among alternatives, the most effective innovative technologies in coherence with the specific needs of healthcare service providers.