Multiple stakeholders from low- and middle-income countries (LMICs) around the world collaborated to reflect on the status of patient involvement in health technology assessment (HTA) in LMICs. Among them, the extent to which HTA exists and is used to inform healthcare decision making varies considerably, and even more so the provision for patient involvement. Patient participation is often ad hoc and depends upon the formal existence, capability, and capacity of patient organisations in selected disease areas. While all participants saw value in patient involvement, a broad range of barriers to improving its consistency and quality were identified. Some countries have started to involve patients more systematically and strategically. To advance the methods and practices in the LMIC setting and context, collaboration and knowledge exchange across countries is recommended, potentially facilitated through regional centres of excellence. Intersecting socio-cultural aspects with clinical and economic evidence can strengthen the acceptance and relevance of HTA in LMICs and promote the utilisation of impactful health interventions attuned to local contexts which can be implemented to improve population health outcomes. A step-by-step approach with open communication or co-creation among internal and external stakeholders to HTA may be instrumental in building processes that are feasible, acceptable, and relevant.