OBJECTIVES: The Innovation and Value Initiative is working with a multi-stakeholder advisory committee to develop a consensus-based framework to incorporate equity considerations into health technology assessment (HTA) in the US. As part of this effort, we conducted a systematic literature review to identify challenges and promising solutions that have been proposed in HTA to advance more equitable assessments.

METHODS: Using PubMed, we identified published articles describing how to incorporate equity considerations into HTA from 2012-2022. Key search terms were decided based on relevance to health equity and HTA. Articles were excluded from full-text review if they were not in English, only documented disparities, or were not related to HTA. We extracted challenges and proposed solutions by domains including data, methods, and processes. Articles from grey literature (n=31) shared by the advisory committee were also reviewed.

RESULTS: 1200 articles were identified for abstract screening. While review is still ongoing, preliminary findings suggested lack of data to better measure heterogeneity in different patient populations (e.g., impacts of the disease, treatment effectiveness), and lack of transparency and interoperability in existing data sources as major barriers to the development of more equitable HTA. Promising methods (e.g., distributional cost-effectiveness analysis) have been proposed to account for the differential impacts of novel health interventions on patient subgroups, but have not yet seen widespread use. There is an increasing emphasis on stakeholder engagement in HTA, but best practices for inclusion of underserved patient subgroups in HTA are needed.

CONCLUSIONS: While promising approaches are emerging, innovative solutions are needed to tackle challenges in data, methods, and processes for more equity-informed HTA. More comprehensive and systematic frameworks on how to incorporate health equity into HTA are needed.