Adaptive health technology assessment to facilitate priority setting in low- and middle-income countries.

INTRODUCTION Traditional health technology assessment (HTA) is a policy-based research process, which aims to improve the efficiency and equity of the healthcare system with the limited financial resources available in healthcare.1 In various countries, traditional HTA has been 'institutionalised'-through the development of dedicated agencies with accepted norms and rules that guide explicit priority setting-over years or decades. These agencies use time-consuming, data intensive and systematic methods and processes which require health economics expertise and resources to make recommendations on how to allocate finite resources.2 There is a growing appetite for HTA and its eventual institutionalisation in low-and-middle income countries (LMICs) driven in part by WHO's recommendation for it to be a critical component to achieving universal health coverage.3 While there are notable LMIC exceptions of introducing and institutionalising HTA (eg, Thailand, Colombia, Brazil and India), others may be constrained by limited technical and administrative capacity, paucity of data, time and governance structures to carry out HTA.4 A more pragmatic approach which we define in this paper as 'adaptive HTA' (aHTA) is one which uses various expedited or flexible methods and processes that are 'fit for purpose' and could help to tackle some of these challenges faced by LMICs. Here, we suggest how policy makers, researchers, clinicians and donors can collaborate and support the development and uptake of aHTA for LMICs to enable expedited evidence-based decision making in these countries as one part of the journey towards HTA institutionalisation.