# Health technology assessment implementation in WHO South-East Asia Region: a realist review protocol

## TL;DR

This study outlines a realist review protocol to assess how health technology assessments can be effectively implemented in the WHO South-East Asia region, with a focus on India.

## Contribution

The study introduces a realist review to explore HTA implementation mechanisms in the WHO South-East Asia region, which has not been previously comprehensively reviewed.

## Key findings

- The realist review will identify HTA methods and their contextual mechanisms in the WHO South-East Asia region.
- Stakeholder consultations will help develop a program theory for HTA implementation in India.
- The findings will inform a framework for policymakers and HTA experts in India.

## Abstract

Background:
A robust Health Technology Assessment (HTA) mechanism is crucial to address the rising burden of healthcare costs and expenditures of patients. This research aims to describe the HTA methods and mechanisms for successful implementation of HTA in the WHO South-East Asia region, and contextualize the synthesized evidence relevant to Indian settings.

Methods:
Realist review involves developing a program theory by conducting a systematic search strategy, screening, study selection, data extraction, and data synthesis. A systematic search for literature will be conducted on PubMed (NCBI), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate), and ProQuest Central for identifying the methods used for HTA of health technology interventions. Stakeholder consultations will be conducted to develop a program theory following the Context-Mechanism-Outcome configurations (CMOcs) framework. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. The proposed realist review will be reported as per the Realist and MEta-narrative Evidence Syntheses: Evolving Standards [RAMESES II] guidelines.

Conclusions:
To our knowledge, there has been no comprehensive review conducted to understand the mechanisms of HTA methods in the WHO South-East Asia region. The findings from the realist review will help us understand the mechanisms through which the HTA could work in WHO South-East Asian countries. We will then contextualize the findings obtained from evidence to Indian settings, based on program theory development through stakeholder consultation. A framework will be developed that can be used by policymakers/HTA experts in India for effective implementation of the same.