Ranked among the top 10 global health threats, antimicrobial resistance (AMR) prompts concern. Embracing a living evidence synthesis (LES), we address this concern by informing health decision-makers about molecular tests for swift detection of multidrug-resistant organisms (MDROs). This updated HTA report for the Spanish National Health System prioritizes decisions based on the most current evidence, adapting to emerging technologies and evidence.

The LES commenced with a baseline synthesis, shaping the initial HTA report regarding rapid molecular test impact on safety, efficacy, effectiveness, and patient outcomes in suspected infection cases. Based on this, on 12 July 2023, we initiated a 12-month evidence monitoring process. Utilizing the Living Evidence to Inform Health Decisions (LE-IHD) framework and interactive tools, we conducted ongoing baseline synthesis and evidence tracking. Artificial intelligence (AI) and the Living Overview of Evidence (L.OVE) platform aided in continual evidence identification. Tri-monthly scans of trial registries unveiled ongoing studies. New eligible studies were rigorously assessed. Updates in HTA conclusions were in line with this synthesis.

The baseline synthesis identified 25 systematic reviews that suggested that the use of rapid molecular test for the identification of pulmonary tuberculosis showed good performance, but less evidence or low-quality evidence was available for other medical conditions or on patient outcomes. During the conference, we will report on 11 months of monitoring and regular updates, including key messages on changes in the evidence synthesis conclusions whenever there are substantial updates of the HTA report.

The living evidence approach enables timely updates of conclusions for HTA reports relying on low- and very low-quality evidence, enhancing their significance in decision-making. The LE-IHD framework streamlines tasks for HTA developers in planning and executing LES to inform health decisions.

The evidence synthesis developed to inform decision-making on the use of cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for pediatric peritoneal carcinomatosis showed that currently available evidence is of very low quality. As new evidence could arise within the following months, we adopted a rigorous living evidence synthesis (LES) approach to provide a timely update and favor decision-making based on actual evidence.

This LES started with a baseline synthesis about the effects of CRS and HIPEC on pediatric peritoneal carcinomatosis. On 31 August 2023, we set up the evidence monitoring for up to 12 months. Following the Living Evidence to Inform Health Decisions (LE-IHD) framework, we planned and developed the evidence monitoring, supported by technological enablers. We searched for ongoing studies in trial registries every three months. New eligible studies were assessed following a systematic and reproducible process to decide on their incorporation in the evidence summary. This process was periodically reviewed to determine the continuation/withdrawal of the living mode.

The baseline synthesis identified one systematic review suggesting that CRS and HIPEC could increase overall survival in pediatric peritoneal carcinomatosis (very low-quality evidence), but no comparative data could be obtained against usual care. To date, the evidence monitoring has not identified new relevant studies on the impact of CRS and HIPEC in overall and disease-free survival, morbidity, or quality of life in pediatric peritoneal carcinomatosis. At the time of the conference, we will report on nine months of monitoring and regular updates including key messages on any changes in the evidence synthesis conclusions.

For HTA reports based on very low-quality evidence (uncertain results), the LE approach allows for timely updating of conclusions, adding value in decision-making. The LE-IHD framework facilitates HTA developers’ tasks for planning and conducting LE synthesis to inform health decisions.

An evidence synthesis developed to inform decision-making on the use of vitamin D for preventing and treating COVID-19 showed that current available evidence is of low to very low quality. We set up a rigorous living evidence to inform health decisions (LE-IHD) approach to provide timely updates of this health technology assessment (HTA) report and aid decision-making.

Following the LE-IHD framework, we developed a baseline synthesis and evidence monitoring on the effects of high-dose vitamin D for the prevention and treatment of severe COVID-19 on all-cause mortality, COVID-19-related hospitalization, intensive care unit admission, length of hospital stay, quality of life, adverse events, and long COVID-19. The evidence identification, screening, and selection processes were supported by Epistemonikos technological enablers and the Living Overview of Evidence platform. We searched for ongoing studies in trial registries every three months. New eligible studies were assessed using a systematic and reproducible process to update the HTA report.

For the baseline synthesis we identified nine randomized control trials (RCTs) assessing high dose vitamin D2, vitamin D3, and their metabolites, which provided very low quality evidence on all the outcomes of interest. Up to date evidence monitoring identified seven studies reporting on all-cause mortality and intensive care unit admission, eight studies reporting on length of hospital stay, and six studies reporting on adverse events. The living evidence synthesis has been updated twice. At the time of the conference, we will report on 10 months of monitoring results and any substantial updates to the HTA report.

For HTA reports based on low and very low quality evidence (uncertain results), the living evidence approach allows for timely updating of conclusions. The LE-IHD framework facilitates the planning and execution of living evidence syntheses to inform health decisions. This living evidence synthesis is being developed as part of a project to strengthen decision-making capacity in the Spanish health system.