How health technology assessment is changing
Health technology assessment is adapting to real-world evidence, faster evidence synthesis and wider stakeholder participation. The COVID-19 pandemic highlighted a further problem: producing and synthesising evidence does not ensure that decision makers will use it.
Evidence production and use
The early COVID-19 pandemic showed inefficient evidence generation and decisions led by prominent professionals' opinions, despite a longer shift toward combining clinical expertise with published research evidence. Large efforts to synthesise evidence do not guarantee that politicians will attend to the resulting reports, and some sceptics turn to social media rather than reputable evidence sources.
A review of literature from 2000–2015 found that assessments' influence was mostly positive, although it varied. Few studies examined clinical-practice or outcome changes; clinical quality registers were proposed as a way to fill this evaluation gap.
Real-world evidence and adaptive synthesis
By 2021, interest in real-world data for assessment was growing, and administrative databases, registries and other repositories offered potential evidence sources. For European medical-device assessments, a review identified a need to coordinate data production, design and analysis and overcome barriers in data quality, quantity and access. A German study found conflicting stakeholder demands, including differences between regulators and assessment bodies. Collaboration and organisation were needed to develop real-world evidence for decisions, together with greater capacity to analyse observational data.
In 2021, assessment was moving toward adaptive synthesis using real-world evidence and rapid approaches such as rapid reviews to become more flexible and user-friendly. These methodological changes challenged traditional evidence-synthesis processes.
Patients and other stakeholders
Patients' involvement is important to using real-world evidence well in clinical-effectiveness research. By 2021, the Patient-Centered Outcomes Research Institute had developed a real-world-evidence training programme intended to improve patient healthcare decisions. Efforts to engage assessment stakeholders were expanding through individual initiatives and a growing international community and its networks.