How Least Developed to Lower-Middle Income Countries Use Health Technology Assessment: A Scoping Review

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.

卫生技术评估（Health Technology Assessment, HTA）是一种为医疗决策提供依据的多学科工具。HTA已在高收入国家（high-income countries, HIC）应用数十年，但直至近年才在低收入及中等收入国家获得日益增长的投入。本研究开展了一项范围综述（scoping review），旨在明确并比较卫生技术评估在最不发达国家及中低收入国家（least developed and lower middle-income countries, LLMIC）中的作用。研究检索了2015年1月至2021年8月期间MEDLINE与EMBASE数据库的文献。本研究采用涵盖卫生技术评估目标、方法、应用地域及合作模式等类别的分类矩阵，用于数据提取与综合分析，以呈现研究结果。本次综述共纳入50篇相关文献。根据实际情况，该分类矩阵被填充内容并进一步细分为更多子类别。本研究着重阐述了卫生技术评估的热点议题，包括为克服已有充分文献记载的数据及能力建设挑战而开展的相关举措，并明确了有待进一步研究的空白领域。本研究发现，尚有诸多领域存在研究不足或应用不充分的问题，包括撤资、早期卫生技术评估/实施、系统层面干预措施以及跨部门合作伙伴关系。本研究探讨了该主题对决策者与研究者的广泛实践启示，旨在进一步强化卫生技术评估与卫生系统之间的协同联动，并为最不发达国家及中低收入国家开展卫生技术评估实践提供可借鉴的建议。尽管高收入国家率先开展了卫生技术评估实践，但最不发达国家及中低收入国家正逐步建立自身的卫生技术评估流程，以助力本国的医疗决策制定。本次综述为最不发达国家及中低收入国家的卫生技术评估实践提供了可供借鉴的前瞻性框架。本研究希望本综述能成为卫生技术评估投资与扩张时代下，优化其应用影响力的及时且具价值的成果，并推动相关讨论与实践落地。