OBJECTIVES: The Next Generation Health Technology Assessment (HTx) project aims to develop novel methods for the health technology assessment (HTA) of complex health technologies. The ongoing pandemic has certainly posed a complex situation for HTA agencies to assess the value of tests and treatments for COVID-19. Robust economic evaluations are needed to help them do so. Therefore, as part of HTx, we sought to review the cost-effectiveness evidence base and understand the key challenges and data gaps facing decision modellers.

METHODS: A “living” systematic literature review was undertaken. Key databases for economic evaluations, grey literature sources and model repositories were searched on July 12^th, 2021. Inclusion and exclusion decisions were made independently by 2 reviewers. Full economic evaluations of tests or treatments for COVID-19, published in English, were included for quality assessment using a NICE checklist. Studies with very serious limitations were excluded. Data were extracted from the remaining, included studies. The data were summarised narratively. Searches will be updated every 6 months.

RESULTS: To date, 3540 unique records have been identified, from which 13 studies meet our inclusion criteria. Following quality assessment, we have included 7 full economic evaluations. All are model-based cost–utility (5) or cost-effectiveness (2) analyses. Five evaluate treatments for COVID-19, while 2 evaluate hypothetical testing strategies. Cost-effectiveness results are sensitive to the effect of treatment on survival and hospitalisation, test accuracy and speed of results, disease severity, and price.

CONCLUSIONS: Treatments for COVID-19 that improve survival, and fast, accurate diagnostic tests, have the potential to be cost effective. However, the evidence base presently remains limited and uncertain, with critical gaps such as utility data. We also identified heterogenous analytical approaches, including the extent to which disease transmission, system capacity constraints, and the long-term effects of COVID-19 have been captured in value assessments.