title: A systematic review of health technology assessment tools in sub-Saharan Africa: methodological issues and implications.
abstract: BACKGROUND
  Health technology assessment (HTA) is mostly used in the context of high- and middle-income countries. Many "resource-poor" settings, which have the greatest need for critical assessment of health technology, have a limited basis for making evidence-based choices. This can lead to inappropriate use of technologies, a problem that could be addressed by HTA that enables the efficient use of resources, which is especially crucial in such settings. There is a lack of clarity about which HTA tools should be used in these settings. This research aims to provide an overview of proposed HTA tools for "resource-poor" settings with a specific focus on sub-Saharan Africa (SSA).
  
  
  METHODS
  A systematic review was conducted using basic steps from the PRISMA guidelines. Studies that described HTA tools applicable for "resource-limited" settings were identified and critically appraised. Only papers published between 2003 and 2013 were included. The identified tools were assessed according to a checklist with methodological criteria.
  
  
  RESULTS
  Six appropriate tools that are applicable in the SSA setting and cover methodological robustness and ease of use were included in the review. Several tools fulfil these criteria, such as the KNOW ESSENTIALS tool, Mini-HTA tool, and Multi-Criteria Decision Analysis but their application in the SSA context remains limited. The WHO CHOICE method is a standardized decision making tool for choosing interventions but is limited to their cost-effectiveness. Most evaluation of health technology in SSA focuses on priority setting. There is a lack of HTA tools that can be used for the systematic assessment of technology in the SSA context.
  
  
  CONCLUSIONS
  An appropriate HTA tool for "resource-constrained" settings, and especially SSA, should address all important criteria of decision making. By combining the two most promising tools, KNOW ESSENTIALS and Multi-Criteria Decision Analysis, appropriate analysis of evidence with a robust and flexible methodology could be applied for the SSA setting.
authors.affiliation: Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), University of Erlangen-Nürnberg, Schwabachanlage 6, Erlangen 91054, Germany. christine.kriza@uk-erlangen.de.
authors.forename: Christine
authors.initials: C
authors.lastname: Kriza
authors.forename: Jill
authors.initials: J
authors.lastname: Hanass-Hancock
authors.forename: Emmanuel Ankrah
authors.initials: EA
authors.lastname: Odame
authors.forename: Nicola
authors.initials: N
authors.lastname: Deghaye
authors.forename: Rashid
authors.initials: R
authors.lastname: Aman
authors.forename: Philip
authors.initials: P
authors.lastname: Wahlster
authors.forename: Mayra
authors.initials: M
authors.lastname: Marin
authors.forename: Nicodemus
authors.initials: N
authors.lastname: Gebe
authors.forename: Willis
authors.initials: W
authors.lastname: Akhwale
authors.forename: Isabelle
authors.initials: I
authors.lastname: Wachsmuth
authors.forename: Peter L
authors.initials: PL
authors.lastname: Kolominsky-Rabas
mesh_terms: D017954:Africa South of the Sahara; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D006291:Health Policy; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D011203:Poverty; D040841:Resource Allocation; D013673:Technology Assessment, Biomedical / Q000379:methods*