Living Health Technology Assessment: Issues, Challenges and Opportunities

Abstract

Health technology assessments (HTAs) are typically performed as one-off evaluations and can potentially become out-of-date due to the availability of new data, new comparators, or other factors. Recently, living approaches have been applied to systematic reviews and network meta-analyses to enable evidence syntheses to be updated more easily. In this paper, we provide a definition for ‘Living HTA’ where such a living approach could be applied to the entire HTA process. Living HTA could involve performing regular or scheduled updates using a traditional manual approach, or indeed in a semi-automated manner leveraging recent technological innovations that automate parts of the HTA process. The practical implementation of living HTA using both approaches (i.e., manual approach and using semi-automation) is described along with the likely issues and challenges with planning and implementing a living HTA process. The time, resources and additional considerations outlined may prohibit living HTA from becoming the norm for every evaluation; however, scenarios where living HTA would be particularly beneficial are discussed.

Issues, Challenges and Opportunities for Economic Evaluations of Orphan Drugs in Rare Diseases: An Umbrella Review

“…Continuous updating of cost-effectiveness models with new data is an unexplored opportunity, especially considering the necessity of post-launch monitoring or real-world data [ 12 , 60 ]. Such a framework has been referred to as a living HTA [ 18 , 72 ].…”

Economic evaluations of artificial intelligence-based healthcare interventions: a systematic literature review of best practices in their conduct and reporting

“…This refers to regular and scheduled updates of recommendations instead of the more traditional 'one-off' decisions. Living HTA presents opportunities as well as challenges (Thokala et al, 2023) and is not yet common practice.…”

What could health technology assessment learn from living clinical practice guidelines?

“…The living guideline approaches most obviously suited to HTA relate to the methods of evidence assessment. The tools to support standard and living systematic reviews are advancing rapidly, and the potential for these to be incorporated within HTA methods have been described by others ( Grammati et al, 2023 ; Thokala et al, 2023 ). To date, most evidence review within living guidelines has been limited to randomised controlled trials (RCTs) of interventions.…”

“…A living approach to HTA could decrease research waste and duplication of effort. The sharing of evidence summaries already happens in clinical practice guidelines ( NICE, 2021 ), and there are steps towards this happening between HTA agencies in Canada, Europe, and Australia, ( PBS, 2022 ; Hogervorst et al, 2023 ), however in reality the confidentiality of pricing arrangements, and the potential for price lowering or disinvestment at future reassessments, will limit the extent of such sharing ( Thokala et al, 2023 ).…”

“…Frontiers in Pharmacology frontiersin.org steps towards this happening between HTA agencies in Canada, Europe, and Australia, (PBS, 2022;Hogervorst et al, 2023), however in reality the confidentiality of pricing arrangements, and the potential for price lowering or disinvestment at future reassessments, will limit the extent of such sharing (Thokala et al, 2023).…”