https://orcid.org/0000-0002-6905-6817
![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
ABSTRACT
Health Technology Assessment (HTA) is a multidisciplinary tool to inform healthcare decision-making. HTA has been implemented in high-income countries (HIC) for several decades but has only recently seen a growing investment in low- and middle-income countries. A scoping review was undertaken to define and compare the role of HTA in least developed and lower middle-income countries (LLMIC). MEDLINE and EMBASE databases were searched from January 2015 to August 2021. A matrix comprising categories on HTA objectives, methods, geographies, and partnerships was used for data extraction and synthesis to present our findings. The review identified 50 relevant articles. The matrix was populated and sub-divided into further categories as appropriate. We highlight topical aspects of HTA, including initiatives to overcome well-documented challenges around data and capacity development, and identify gaps in the research for consideration. Those areas we found to be under-studied or under-utilized included disinvestment, early HTA/implementation, system-level interventions, and cross-sectoral partnerships. We consider broad practical implications for decision-makers and researchers aiming to achieve greater interconnectedness between HTA and health systems and generate recommendations that LLMIC can use for HTA implementation. Whilst HIC may have led the way, LLMIC are increasingly beginning to develop HTA processes to assist in their healthcare decision-making. This review provides a forward-looking model that LLMIC can point to as a reference for their own implementation. We hope this can be seen as timely and useful contributions to optimize the impact of HTA in an era of investment and expansion and to encourage debate and implementation.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Ethics
Ethics approval was not required because we did not collect primary data or work directly with participants.
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/20477724.2022.2106108
Notes
1 NICE’s first appraisal was to recommend healthy wisdom teeth should not be removed, estimated to save the NHS £5 m a year. The first clinical guideline was in mental health and was developed to cover the patient pathway from diagnosis to treatment. This had significant effect as there was then little in the way of guidance for mental health nationally or internationally. The Citizens’ Council was established providing a public perspective on ethical issues. The broad and inclusive nature of its various committees is a recognized strength of NICE. 20 years of NICE.
4 About Us | iDSI (idsihealth.org).
6 Second WHO HTA survey published December 2021.
7 We use this abbreviation referring to Least Development Counties (LDC), and Low-Income Countries and Lower Middle-Income Countries which are not LDC according to the OECD Development Assistance Committee list: https://www.oecd.org/dac/financing-sustainable-development/development-finance-standards/daclist.htm
8 We recognize some UMIC, for example, Thailand have progressed with HTA further than others.
9 Unpublished MSc Global Health dissertation (AF), supervised by JB and EG.
10 WHO HTA survey responses were received between 24 February 2015 and 31 August 2015.
11 Jordan reclassified as UMIC in 2022. Updates delayed regarding classifications according to DAC list on an exceptional basis in the light of the ongoing global pandemic.
12 Lists are non-exhaustive but highlight key data extracted.
13 For example, NICE’s guidance is mandatory yet it cannot suggest where the money should come from to fund the technologies it recommends. Other countries more explicitly consider budget impact as part of their HTA (Australia), and others are dominated by the budget (New Zealand).
14 Although some mention was made of other aspects, for example social, legal, ethical, equity and feasibility of implementation, there were notably less discussed (Teerawattananon, 2016). This was a similar finding as that in the WHO survey.
15 Lists are non-exhaustive but highlight key data extracted.
16 Global partnership to make available 120 million affordable, quality COVID-19 rapid tests for low- and middle-income countries (who.int)
17 Early HTA is still an emerging field with limited guidance on methods but will differ according to the purpose and audience of HTA. It may not be easy or, in fact, desirable, to create guidance for all early HTA. Given that it is such a broad church, different approaches are suitable for different situations (including the amount of resources available to spend on HTA). The rigor required will depend on the needs of the audience for the HTA. For example, an exploratory analysis conducted privately for a technology developer to inform potential pricing policy may not require the same level of rigor as a decision on a potential screening programme for a national health provider. In all cases, we would encourage clarity of reporting of methods adopted and limitations of those methods.
18 Strategy Report: Engaging the private health service delivery sector through governance in mixed health systems. Geneva: World Health Organization; 2020. License: CC BY-NC-SA 3.0 IGO
19 WAHO | West African Health Organization (wahooas.org)
20 The Health Economics Unit (HEU) at the Africa Centers for Disease Control and Prevention (Africa CDC) was launched in collaboration with the Center for Global Development (CGD) to facilitate evidence-based priority-setting during the pandemic and beyond.
22 For example, NICE (and HTA in other countries, including Australia) does not help the health service to ’save money’. In fact, health spending continues to increase with investment in expensive new treatments according to NICE recommendations. Efficiency – which is the criteria the UK focuses on for it decision-making – is about value for money, spending on treatments that provide sufficient health returns.
23 To quote NICE’s December 2020 newsletter: ‘Over the last 20 years, NICE has established itself as a global leader in the development of evidence-based guidance for health and social care … but it is only by putting this advice into practice that it will make a difference to real people, to health outcomes and to equitable access to services’.
