To achieve universal health coverage (UHC), countries must make difficult choices to optimize the use of scarce resources. There is a growing interest in using evidence-based priority setting processes, such as Health Technology Assessment (HTA), to inform these decisions. In 2020, the Palestinian Institute of Public Health (PNIPH) and the Norwegian Institute of Public Health (NIPH) initiated a pilot to test the feasibility of coproducing an HTA on breast cancer screening in the West Bank, occupied Palestinian Territory. Additionally, a secondary aim was to test whether using an adaptive HTA (aHTA) approach that searched and transferred published evidence syntheses could increase the speed of HTA production.

The applied stepwise approach to the HTA is described in detail and can be summarized as defining a core team, topic selection, and prioritization; undertaking the HTA including adaptation using tools from the European Network for HTA (EUnetHTA) and stakeholder engagement; and concluding with dissemination.

The aHTA approach was faster but not as quick as anticipated, which is attributed to (i) the lack of availability of local evidence for contextualizing findings and (ii) the necessity to build trust between the team and stakeholders. Some delays followed from the COVID-19 pandemic, which showed the importance of good risk anticipation and mitigation. Lastly, other important lessons included the ability of virtual collaborations, the value of capacity strengthening initiatives within low- and middle-income countries (LMICs), and the need for early stakeholder engagement. Overall, the pilot was successfully completed.

This was the first HTA of its kind produced in Palestine, and despite the challenges, it shows that HTA analysis is feasible in this setting.

Health technology assessment (HTA) can play a key role in evidence-based decision-making. However, HTA requires resources that might be lacking in low-income settings. To test the feasibility of adapting existing evidence as part of the HTA process, this project evaluated the effectiveness and economic impact of breast cancer screening programs for women over 40 years in the West Bank, where mammography screening is provided for free in governmental clinics.

We conducted a search for systematic reviews, HTAs and guidelines in electronic databases. We included the most recent global systematic review and meta-analysis that fulfilled our inclusion criteria. The European Network for Health Technology Assessment (EUnetHTA) adaptation toolkit was used to guide adaptation and undertake a budget impact analysis of the economic impact of mammography screening. We build capacity by working as a team of HTA experts and first-time HTA researchers. The results were disseminated to raise awareness for HTA.

The European Commission Guidelines on Breast Cancer Screening were identified as most recent global systematic review with meta-analyses, out of 2,365 references. The adapted evidence may inform policies on screening in the West Bank. Our experience is that adaption requires extensive skills and resources, including finding, assessing, and adapting relevant evidence. The EUnetHTA toolkit is useful, but also adds to the workload. Furthermore, local stakeholder engagement is important in topic selection, to access information, and to contextualize global evidence to the local setting.

This study is currently ongoing, but preliminary findings show that producing an HTA by adapting existing evidence in resource-limited settings is feasible. There is a need for nuanced guidance on transferability of evidence from other settings. Future studies should investigate innovative methods to optimize the adaption process. Capacity building in adaptation is important to ensure the production of quality HTA products. Inclusion of local team members and stakeholders is important for future development of HTA in the region.