Table 1

Methods and trade-offs for adapting traditional health technology assessment (HTA) in low- and middle-income countries (LMICs)

Traditional HTAAdaptive HTA in LMICs*Trade-offs
Timeline8–12 months+1–6 months
  • Level of comprehensiveness.

  • Speed.

Topic selectionDetailed topic selection process with established criteria and fits government priorities.No process or
Opportunistic process or
Minimal criteria.
  • Identifies low-hanging fruits.

  • Local relevance.

  • Range of topics.

AnalysisDe novo economic evaluation (eg, cost-effectiveness analysis).Price benchmarking or
Literature reviews or
Adapted economic evaluation or
Outsourced economic evaluation.
  • Accuracy.

  • Quality.

  • (Un)certainty.

  • Builds capacity.

  • Leverages available data.

Data sourcingLocal studies+primary data collection and systematic literature review/meta analyses as needed.Pragmatic/sources known to authors.
  • Level of comprehensiveness.

AppraisalMultistakeholder group guided by agreed principles appraises evidence and makes policy recommendations.No appraisal or
Modified appraisal process.
  • (Sub)optimal decisions.

  • Level of HTA system improvement and health system strengthening.

ImplementationWide ranging policy changes could include adjustment to health benefits packages, essential medicines lists (including appropriate indications), price negotiations, reimbursement decisions, clinical guidelines, care pathways and quality standards.*
  • (Sub)optimal allocation of resources.

  • Mobilises HTA institutionalisation.

  • Table 1 demonstrates potential different approaches for each step of a traditional HTA versus an adapted HTA for the LMIC context. Depending on the adaptation(s) selected, a range of potential trade-offs could be associated with each of these steps which should be considered when using aHTA, as well as the alternative of using no evidence at all.

  • *While aHTA and traditional HTA can inform similar policy decisions, aHTAs cannot be used for all technologies, as discussed below.

  • aHTA, adaptive HTA.