Experience in developing Living Evidence Synthesis to Inform Health Decisions in HTA and CPG of the Spanish health system

Article type
Authors
Auladell-Rispau A1, Cantor F2, Rada G3, Rojas M4, Urrutia G5, Verdugo F2
1Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
2Epistemonikos Foundation, Santiago de Chile, Chile
3Epistemonikos Foundation, Santiago de Chile, Chile; Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile
4Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cochrane Iberoamerica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Evaluation Unit of the Canary Island Health Service (SESCS), Tenerife, Spain
5Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cochrane Iberoamerica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
Abstract
Background
The Living Evidence and Real-World Evidence Program, a spin-off of the Sant Pau Institute of Research in Barcelona, stems from the innovation and opportunities of the Living Evidence to Inform Health Decisions project, supported by a H2020 MSCA awarded to MX Rojas. The program conducts research to enhance the production, utilization, and application of living evidence synthesis (LES) and real-world evidence (RWE) across various knowledge transfer scenarios. It also offers support services to facilitate capacity building among organizations involved in producing evidence to inform decisions. This support extends to integrating RWE into LES for health decision-making and assists in generating, maintaining, and periodically reporting the LES necessary for informing clinical guidelines and health technology evaluations, among other applications.
Objective
To outline the experience and challenges encountered by our program over 2 years of collaboration with Spanish health system organizations, focusing on the production of LES to inform real-world clinical and policy decisions
Methods
Using a "learning-by-doing" approach, we assisted groups in developing LES from planning to final report, encompassing evidence surveillance and monitoring processes. Employing the web-based Living Evidence to Inform Health Decisions (LE-IHD) framework tool and its handbook, we guided groups applying appropriate criteria at all stages, including identifying relevant questions for "living mode," protocol development, conducting baseline synthesis, monitoring emerging evidence, and incorporating findings into health decisions. We offered training via online modules and provided free access to technological tools supporting evidence surveillance.
Results
Since September 2022, we've supported 8 organizations, primarily HTA agencies, in developing 14 LES as part of their commissioned projects. The evidence identification, screening, and surveillance have been facilitated through the Epistemonikos Foundation's Living Overview of Evidence (L.OVE) platform. By September 2024, we will have 18 months' worth of results from evidence surveillance and will provide updated results on key aspects related to these LES. Currently, the likelihood of an eligible study emerging within 12 months of evidence monitoring is very low (<0.05), with an even lower probability of new studies addressing outcomes crucial for decision-making.
Conclusions
Our ongoing studies indicate that while the LE approach proves highly effective in fields with abundant scientific output, it may not be equally effective for the majority of questions identified as priorities for health systems.