G. Rapid HTA

In recent years, the demand for HTA by health care decision makers has increasingly involved requests for faster responses to help inform emergent decisions. This has led to development of “rapid HTAs” (or “rapid assessments” or “rapid reviews”). Among the reported purposes of rapid HTAs are to inform coverage decisions, capital funding, formulary decisions, treatment referrals, guideline formulation, and indications for further research (Hailey 2009). For these, HTA organizations generate more focused assessments in the course of, e.g., four-to-eight weeks. Rapid HTAs offer a tradeoff: provide less-than-comprehensive and less certain information in time to act on a decision versus comprehensive and more certain information when the opportunity to make an effective decision may have passed. In addition to the shorter completion time, rapid HTAs can differ from full HTAs in such ways as: limiting scope to fewer types of impact or evidence questions, focusing searches on fewer bibliographic databases, relying on fewer types of studies (e.g., only systematic reviews or only RCTs), use of shorter and more qualitative syntheses with categorization of results without meta-analyses, and more limited or conditional interpretation of findings or recommendations (Khangura 2012).

Despite the increased use of rapid HTAs on diverse topics and a growing literature on their responsiveness and utility for decision makers, there is no consensus regarding methodology or guidance for rapid HTAs (Harker 2012). EUnetHTA has a version of rapid HTA that focuses on four of the nine total domains of its HTA core model, i.e., health problem and current use of technology, description and technical characteristics, safety, and clinical effectiveness (EUnetHTA Joint Action WP5 2013). The Ottawa Hospital Research Institute has developed an eight-step approach to rapid reviews, including: needs assessment, question development and refinement, proposal development and approval, systematic literature search, screening and selection of studies, narrative synthesis of included studies (including assignment of evidence levels), report production, and ongoing follow-up and dialog with knowledge users (Khangura 2012). Given the need to tailor rapid HTAs to the particular needs and time constraints of decision-makers, providing transparency of various rapid HTA methodologies is likely to be more important that achieving consensus on any standard approach (Watt 2008).