TY - JOUR T1 - Living health technology assessments: how close to living reality? JF - BMJ Evidence-Based Medicine JO - BMJ EBM DO - 10.1136/bmjebm-2022-112152 SP - bmjebm-2022-112152 AU - Grammati Sarri AU - Anna Forsythe AU - Jamie Elvidge AU - Dalia Dawoud Y1 - 2023/02/16 UR - http://ebm.bmj.com/content/early/2023/02/16/bmjebm-2022-112152.abstract N2 - Healthcare decision-makers are exploring more responsive, innovative processes in the wake of the COVID-19 pandemic, including a ‘living’ approach to health technology assessment (HTA).1 Even before the pandemic, the use of real-world data (RWD) and the advent of mobile and digital health technologies were transforming HTA decision making.2These developments coincided with a broad recognition that keeping pace with rapid publication of new evidence and variation/inefficiencies in review can lead to HTA decisions based on out-of-date evidence.3 These challenges hinder timely patient access to promising, innovative health technologies when decision-makers are asked to accept higher uncertainty in the evidence base, especially in populations with substantial unmet need.4 More reactive and flexible ‘living’ approaches to HTA should be explored.This commentary outlines challenges of current, ‘static’ HTA approaches, offers solutions provided by a ‘living’ HTA approach, and considers implementation of this method.HTA processes have remained largely unchanged, but innovative study designs (eg, pragmatic and adaptive clinical trials, single-arm trials) are transforming evidence generation, while regulatory decisions are increasingly being based on surrogate endpoints rather than primary outcomes.5 This introduces uncertainties which require supplemental data to validate additional assumptions in the analyses.6 7Recently, managed entry arrangements were developed to regulate reimbursement of new technologies with promising but uncertain benefits. For example, coverage with evidence development (CED) schemas grant patients temporary access to novel treatments while additional evidence is systematically collected.8 Decision making based on CED, however, largely ignores a technology’s ‘lifecycle’ … ER -