Health technology assessment 2025 and beyond: lifecycle approaches to promote engagement and efficiency in health technology assessment.

Lifecycle considerations have always been part of health technology assessment (HTA). However, the concept of taking a fuller, more holistic "lifecycle approach" is gaining interest in the HTA community. The 2022 HTAi Global Policy Forum (GPF) discussed how adopting a lifecycle approach could promote stakeholder engagement and robust evidence generation, and whether it could enhance information sharing and transparency across stakeholder groups. This article summarizes the discussions held at the 2022 HTAi GPF and subsequent HTAi Annual Meeting panel session that debated some of the key challenges and opportunities, with particular focus on the pre- and postmarket and disinvestment phase activities. Core themes and recommendations identified that collaboration and patient involvement are happening but still needs to be strengthened, and moving to disease-based approaches may help, although individual contexts still need to be considered. Appropriately developed and mandated core outcome sets may help with information sharing and efficiency in all lifecycle activities. Further, methods for the appropriate use of big data and digital data collection should be developed and driven by the HTA community. The value of lifecycle activities should be reviewed; in particular, scientific advice appears valuable, but the magnitude of effect is somewhat unknown due to the challenges around the confidential nature of these activities. Not all lifecycle activities can be conducted for every technology, and while there is a move away from disinvestment phase activities, more structured prioritization criteria are required. This article ends with suggested next steps to bring forward some of the priority recommendations.

The impact of trial baseline imbalances should be considered in systematic reviews: a methodological case study.

OBJECTIVES: It is possible for baseline imbalances to occur between treatment groups for one or more variables in a randomized controlled trial, although the identification and detection of baseline imbalances remain controversial. If trials with baseline imbalances are combined in a meta-analysis, then this may result in misleading conclusions. STUDY DESIGN AND SETTING: The identification and consequences of baseline imbalances in meta-analyses are discussed. Metaregression using mean baseline scores as a covariate is proposed as a potential method for adjusting baseline imbalances within meta-analysis. We will use a recent systematic review looking at the effect of calcium supplements on weight as an illustrative case study. RESULTS: Meta-analysis conducted using the mean final values of the treatment groups as the outcome resulted in an apparent, statistically significant, treatment effect. However, using a meta-analysis of baseline values, this was shown to be due to the baseline imbalance between treatment groups, rather than as a result of any intervention received by the participants. Applying the method of metaregression demonstrated that there was in fact a smaller, statistically insignificant effect between treatment groups. CONCLUSION: The meta-analyst should always consider the possibility of baseline imbalances and adjustments should be made wherever possible.

A systematic review of the effects of calcium supplementation on body weight.

Animal studies and epidemiological studies have suggested that Ca supplementation (with Ca supplements or dairy products) may be associated with weight loss in human adults. We aimed to assess whether any association was present by reviewing relevant randomized controlled trials in human subjects. The study was a systematic review and subsequent meta-analysis of randomized controlled trials that used Ca supplementation as an intervention in persons 18 or more years of age, and that reported body weight as a final outcome. A total of thirteen randomized controlled trials were included in the meta-analysis. There was no association between the increased consumption of either Ca supplements or dairy products and weight loss after adjusting for differences in baseline weights between the control and intervention groups (P=0.19 and 0.85, respectively). We therefore concluded that Ca supplementation has no statistically significant association with a reduction in body weight.