Living Systematic Review (LSR) in Health Technology Assessment (HTA): Current Guidance, Methods, and Challenges

OBJECTIVES: Health technology assessments (HTAs) rely on systematic literature reviews (SLRs) to inform various analyses. Traditional SLRs are not easily updatable, leading to outdated findings. Living approaches with updates incorporating new evidence, have been proposed as a solution. This literature review aims to gather existing guidance on living SLR methods, including challenges and benefits.

METHODS: A literature review was conducted to identify publications and grey literature discussing challenges, benefits, or methods for living SLR in HTA. Relevant studies were also identified through bibliomining. Screening was performed using the AutoLit software with Robot Screening assistance. Included records reported methods, challenges, or benefits of living SLR or living evidence approaches in HTA. Findings were analyzed using Qualitative Synthesis.

RESULTS: Living SLR Guidance and Methods: Existing literature indicates a lack of specific methodological guidance for implementing living SLR in HTA. Operationalized methods--or even "starter guides"--are needed to assist researchers and practitioners in effectively conducting living SLRs. Living SLR Challenges: The main challenge of living SLR in HTA is labor-intensive processes. Continuous monitoring, screening, data extraction, and analysis require significant resources and time commitment. Concerns regarding whether automation can provide reliability and credibility of living SLR outputs may hold back labor-saving technologies. Living SLR Benefits: Living SLR in HTA enhances standardization and replicability of the review process, ensuring consistent and transparent methods across assessments. The prompt incorporation of new evidence improves decision-making by providing up-to-date and informed recommendations.

CONCLUSIONS: Living SLR has great potential for HTA but requires addressing challenges such as the lack of specific methodological guidance and labor-intensive review workflows. Comprehensive guidelines and automation options should be developed while maintaining rigorous quality assurance. Continued research and collaboration are crucial for advancing the field and promoting widespread adoption of living SLR in HTA, leading to enhanced evidence-based decision-making in healthcare.