What each step of an assessment produces for publication
Health technology assessment generates literature at several stages, from horizon scanning and evidence synthesis to economic evaluation and studies of implementation. The output depends on the work done at each step and the readers who will use it.
The assessment sequence and publication outputs
Limited assessment resources require agencies to prioritise new technologies, most often by their expected clinical or economic impact and the evidence available to assess them. The assessment sequence and its publication outputs are:
| Step | Work and publication output |
|---|---|
| Identifying topics | Topics come from earlier studies’ research recommendations, government or other decision-maker requests, or horizon scanning of trial databases, manufacturers’ websites and the general literature. Horizon-scanning findings are occasionally published. |
| Specifying the decision problem | A scoping exercise commonly uses PICO: patients or population, the new intervention, current alternatives such as standard care, and outcomes of interest. Some versions add S for study design. |
| Searching for evidence | An effective strategy covers published and grey literature. Systematic-review publications normally report the strategy and search outcomes, typically with a PRISMA diagram of records or abstracts identified, exclusions and reasons, and those selected for full review. |
| Systematic review of clinical evidence | The review is almost always published separately or within the assessment report. It usually seeks a meta-analytic estimate of relative clinical effect against a comparator, but may use narrative synthesis if a pooled estimate would mislead or be unhelpful. Publication bias, study quality and heterogeneity need consideration. |
| Economic evaluation | Not every assessment includes one; in 2021 it was becoming more common as resource-allocation pressures increased. It may appear within the report and as a separate paper. |
| Social, legal and ethical implications | Adoption may require legislative changes or conflict with religious, social or political principles. These implications may be discussed in the report but seldom produce separate publications. |
| Recommendations and policy implementation | Recommendations and implementation aim to improve healthcare provision; implementation studies are sometimes published separately. |
| Monitoring impact | Studies monitoring the effect of HTA findings are sometimes published separately. |
Readers of the resulting literature
By 2021 increased use of evidence in medical decisions had expanded published systematic reviews and economic evaluations, and further growth was expected. Readers include clinical practitioners, policymakers and patient organisations as well as researchers familiar with the terminology. Medical writers can help authors make these publications accessible to users with different backgrounds and interests.