Health technology assessment (HTA) is a quintessential component of universal health coverage because of its ability to inform strategic decision-making by providing comprehensive evidence. However, as a byproduct of this comprehensiveness, performing an HTA is laborious, resource-intensive, and time-consuming. Recognizing the importance and shortcomings of HTA, new methodologies such as rapid HTA and Adaptive HTA have emerged. Each method plays a distinct role in the evolving landscape of healthcare decision-making, offering unique advantages and addressing specific challenges.[1]
First, a brief overview of HTA. It is a multidisciplinary process that utilizes explicit methods to comprehensively evaluate the value of health technology by systematically gathering evidence from all possible sources, evaluating the risk of bias from within each evidence source, meticulously analyzing the gathered data, and elaborate reporting in sufficient detail in such a way to permit reproducibility of the methods. The primary objective of HTA is to inform decision-making, ensuring that choices made in healthcare are equitable, efficient, and of high quality.[1]
Rapid-HTA is an expedited modification of the HTA, with a core objective of providing timely information for decision-making, especially in situations where there is urgency or a need for rapid policy responses. In other words, a rapid HTA is a streamlined and accelerated version of traditional HTA, designed to provide quick assessments of health technologies, often with limited data and resources. While traditional HTAs can take several months to complete, rapid HTAs aim for a quicker turnaround of a few weeks to 1-2 months. There is often flexibility in the rapid HTA methodology to respond quickly to emerging issues and to accommodate resource constraints. The stress is on the quickness of methodology while being focussed on the most essential outcomes; to achieve this, there is often early and extensive stakeholder engagement, utilization of streamlined methodologies focusing on critical aspects such as clinical efficacy and safety, and the implementation of parallel processes to expedite data collection, analysis, and decision-making. The streamlined process in rapid HTAs significantly reduces the time required for evidence synthesis and analysis, allowing for quick and informed decision-making. This not only optimizes resource utilization but also ensures timely responses to urgent policy questions. [2,3]
While rapid HTA prioritizes speed over the depth of analysis, this can potentially lead to limitations in the quality and comprehensiveness of the evidence considered. The accelerated timeline of rapid HTA may result in a reliance on limited data, potentially overlooking crucial aspects of a health technology’s value or risks and a potential compromise in the comprehensive understanding of the nuances associated with a health technology. These limitations underscore the necessity for a more adaptive approach. Adaptive HTAs address these shortcomings by allowing for ongoing adjustments and refinements to the assessment process.[3]
Adaptive HTA is an approach that recognizes the need for flexibility in the HTA process, allowing for adjustments based on emerging evidence and stakeholder input. Unlike traditional HTA, adaptive HTA embraces an iterative and flexible framework that can adapt to emerging evidence and changing circumstances. Adaptive HTAs work with the objective of addressing uncertainties and adapting assessments over time as new data becomes available, allowing for more responsive and dynamic decision-making. There is an emphasis on ongoing, iterative processes that can be updated as new evidence emerges, making it less bound by a fixed timeline. In essence, adaptive HTA is a flexible methodological adaptation, finely attuned to the unique practical considerations and needs of specific contexts. This adaptive approach does not adhere to a rigid, one-size-fits-all structure but rather tailors its methods and processes to suit the nuanced requirements of different health systems.[3,4]
Adaptive HTA exhibits versatility by leveraging international data, economic evaluations, and decisions from established HTA agencies, expediting policy decisions while considering concerns of transferability and uncertainty. This pragmatic approach adheres to key HTA principles, including transparency, independence, consultation, and contestability. Despite its adaptive nature, adaptive HTA maintains the integrity of these principles, ensuring robust and credible evaluations. This fit-for-purpose approach positions adaptive HTA as a dynamic and responsive tool in healthcare decision-making, especially in settings facing constraints or requiring flexibility. Its advantages include dynamic decision-making, optimizing resource allocation through an iterative process, and providing clarity on innovation’s impact by reducing uncertainty. However, the iterative nature introduces complexity, demanding careful management of decision points and ongoing monitoring. Additionally, the resource intensiveness of continuous monitoring and adaptation may challenge the capacity of some healthcare systems.[3,4]
As decision-makers navigate this intricate landscape, the synergy between evidence, speed, and adaptability emerges as the key to unlocking a more efficient, equitable, and patient-centric healthcare future. The seamless integration of these methodologies into healthcare systems holds the potential to revolutionize how emerging health technologies are assessed, adopted, and leveraged for the betterment of global healthcare.
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References
- Hailey D, Corabian P, Harstall C, Schneider W. The use and impact of rapid health technology assessments. International journal of technology assessment in health care. 2000 Apr;16(2):651-6.
- Schünemann HJ, Moja L. Reviews: rapid! rapid! rapid!… and systematic. Systematic Reviews. 2015 Dec;4(1):1-3.
- Nemzoff C, Ruiz F, Chalkidou K, et al. Adaptive health technology assessment to facilitate priority setting in low‑and middle‑income countries. BMJ Glob Health. 2021.
- Nemzoff C, Shah HA, Heupink L, et al. Adaptive health technology assessment: a scoping review of methods. Value in Health. 2023 Jun 5.