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International Journal of Technology Assessment in Health Care logoLink to International Journal of Technology Assessment in Health Care
. 2026 Feb 16;42(1):e29. doi: 10.1017/S0266462326103535

A systematic literature review (SLR) on the adoption of artificial intelligence-assisted SLRS: implications for health technology assessments

Seye Abogunrin 1,✉, Yifei Liu 1,2, Clarissa Higuchi Zerbini 1
PMCID: PMC13071852  PMID: 41692687

Abstract

Objectives

Systematic literature reviews (SLRs) are essential for evidence synthesis in healthcare decision making, including health technology assessment (HTA), but their time and resource demands are substantial. Artificial intelligence (AI) may enhance efficiency of conducting SLRs, but its acceptance by HTA bodies remains underexplored. This SLR quantifies published health-related SLRs reporting AI use, identifies AI tools used at each SLR stage, and evaluates HTA guidance on AI in evidence synthesis.

Methods

We searched Embase, Medline, and the Cochrane Library (up to 9 September 2025), supplemented by hand searches and reviews of HTA agency websites. Titles and abstracts were screened in Rayyan by a single reviewer, with full-text review confirming eligibility. Data were extracted and synthesized narratively along key themes.

Results

In total, 112 studies covering 111 unique SLRs were identified, reporting 134 implementations of 45 unique AI tools (29 publicly available; 16 custom-built). AI use has risen since 2013 and was most frequently applied during title and abstract screening (88 of the 134 implementations). Human oversight remained essential, with no fully autonomous AI reported. Three HTA agencies (CDA-AMC, IQWiG, NICE), EUnetHTA, JBI and Cochrane have provided guidance, indicating the formal integration of AI into HTA processes.

Conclusions

This SLR provides a quantitative overview of AI use in health-related SLRs and current HTA guidance. These findings may inform development of clearer methodological recommendations and support integration of AI-assisted evidence synthesis in HTA submissions. Further research and policy development are needed to optimize its role in evidence synthesis and healthcare decision making.

Keywords: artificial intelligence, machine learning, systematic review, health technology assessment, healthcare decision making

Introduction

Health technology assessment (HTA) is a multidisciplinary process that evaluates the safety, effectiveness, and cost-effectiveness of health technologies (1). By considering clinical, economic, social, ethical, and organizational aspects, HTAs inform decisions on adopting, reimbursing, or implementing new and existing technologies (1). Systematic literature reviews (SLRs) are the gold standard for evidence synthesis in HTA and inform dossiers prepared by health technology developers for review by HTA bodies as part of their decision-making process (2). Their transparent, reproducible methodology ensures comprehensive evaluation of all relevant literature for a given indication (3), and they serve as a precursor to meta-analyses and indirect comparisons (4).

SLRs involve several complex stages, including defining research questions and search strategies, developing a protocol, screening studies, extracting data, assessing risk of bias, and synthesizing findings (3). They require substantial time, budget, and human resources, and typically take over 67 weeks to complete (5). The lengthy process can render findings outdated by the time of publication (6) and delay decision-making and patient access to treatments. HTA bodies require that SLR searches are performed within 3–6 months of dossier submission, adding further logistical challenges for researchers (2;7). SLRs also demand significant financial resources, requiring expert teams, access to specialized databases and software, and periodic updates to maintain relevance (5;6;8). Consequently, a single SLR can cost up to US$141,194.80 (9). Despite these challenges, methodological rigor remains critical for minimizing bias and supporting evidence-based HTA decisions (3).

Artificial intelligence (AI), the simulation of human intelligence for tasks that involve learning, reasoning, and prediction (10), has the potential to alleviate the burden of repetitive tasks while preserving human oversight (11). Researchers have explored the use of AI to streamline and expedite various steps of the SLR process (12). Advances in natural language processing (NLP) and machine learning (ML) have enhanced the feasibility of integrating AI into SLRs and evidence synthesis (13). NLP, including large language models (LLMs) such as ChatGPT, enables machines to interpret and generate human language, and ML allows systems to learn from data (14). These technologies could enable faster, more efficient evidence synthesis to support timely decision making (13).

Understanding how HTA bodies view AI-assisted evidence synthesis for HTA submissions is crucial for developing recommendations for its use. Although some agencies have issued recommendations (15–18), many have not defined their position on the adoption of AI technologies in the evidence-synthesis process. Slow adoption of AI by HTA bodies could hinder the exploration and implementation of more dynamic HTA approaches, such as living HTAs and living reviews, which could also be assisted by AI. Furthermore, the increasing workload due to the new EU HTA Regulation (Regulation [EU] 2021/2282), which introduces joint clinical assessments across EU member states and requires consideration of multiple national PICOs within a single assessment, could be better managed using AI (7;19;20).

This study aimed to (i) quantify published health-related SLRs reporting AI use; (ii) identify AI tools used at each SLR stage and their functionalities; and (iii) determine if HTA agencies accept or recommend the use of AI tools. By addressing these questions, the study seeks to clarify the extent of AI adoption in evidence synthesis and its implications for HTA decision making; it does not examine specific AI methodologies used in SLRs (e.g., ML, deep learning, neural networks) because these have been covered in previous research (21).

Methods

To identify AI-supported SLRs within the field of health-related research, an SLR was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (22). This included structured searches across multiple databases, narrative synthesis, and risk-of-bias assessment using the Risk Of Bias In Systematic Reviews (ROBIS) tool. The protocol for this SLR was preregistered with the Open Science Framework (protocol identifier: osf.io/6tavf).

Information sources and search strategy

Three databases were searched to identify relevant AI-supported SLRs: Embase (via Ovid), Medline (via Ovid), and the Cochrane Library (Cochrane Reviews), covering all records from database inception to 25 June 2024, with updated searches conducted on 9 September 2025. To ensure comprehensive coverage, the bibliography lists of included studies were manually reviewed between 17 June and 5 July 2024, and between 3 October and 7 October 2025, to identify potentially eligible articles that may have been missed by the database searches.

The search strategy incorporated key terms related to AI and systematic reviews. The primary keyword combination included (“artificial intelligence” OR “machine learning” OR “deep learning” OR “automation” OR “text mining” OR “natural language processing” OR “large language model” OR “generative AI”) AND “systematic review.” Additionally, the “artificial intelligence” query string was combined with the names of AI tools specifically developed to assist with SLRs, identified through prior knowledge and online searches (Supplementary Tables 1 and 2).

Only articles involving human participants and review articles were included, with the search limited to English-language publications.

Supplementary searches

To identify guidelines from HTA agencies on the use of AI tools for SLRs, the methodological guidelines or guidance sections of HTA agency websites were systematically searched between 17 June and 5 July 2024, and between 3 October and 8 October 2025. This included all fifty-three members of the International Network of Agencies for Health Technology Assessment (INAHTA), with the full member list available at https://www.inahta.org/members/members_list/. The website of the European Network for Health Technology Assessment (EUnetHTA), which is not a member of INAHTA, was reviewed to capture any relevant guidance.

Broader methodological frameworks commonly referenced by HTA bodies were also considered. These included the Cochrane Handbook (23), Centre for Reviews and Dissemination guidance (24), and the Joanna Briggs Institute Manual for Evidence Synthesis (25).

Eligibility criteria

Owing to the nature of the research questions, the eligibility criteria based on the PICO framework (Population, Intervention, Comparator, Outcomes) were not suitable for this analysis. Instead, a set of concept-driven eligibility criteria relevant to the study objectives were applied to ensure a comprehensive yet focused selection of relevant studies.

Eligible articles included SLRs or reviews that employed a systematic approach, focused on human health and medical research, and reported the use of AI tools to assist in the literature review process. Studies were excluded if they only mentioned the use of reference management or screening platforms, such as Covidence or Rayyan, without confirming the use of their AI or ML functionalities. Conversely, studies using software inherently designed for AI-based active learning (e.g., ASReview) were included because its core screening functionality relies on ML algorithms. Conference abstracts, review protocols, and preprint articles were excluded to maintain a focus on fully peer-reviewed published studies.

Overview of the screening process

Articles from database searches were first deduplicated in EndNote, then further deduplicated in Rayyan. Screening was conducted in Rayyan, beginning with title and abstract screening based on the prespecified eligibility criteria. Full texts of the studies that met the inclusion criteria were reviewed to confirm eligibility before data extraction. Screening, full-text review, and data extraction were conducted collaboratively by multiple reviewers.

Data extraction

The following data were extracted in an Excel sheet using Rayyan: authors, article title, year of publication, type of author affiliations, type of review, topic of review, name of the AI tools used, functionalities of the AI tools, stages of review for which the AI tool was employed, whether human reviewers were involved, and the advantages and disadvantages of using the tool.

Tools designed for automating meta-analyses were beyond the scope of this review and, therefore, were not included. In cases when the functionalities and features of an AI tool were unclear, the tool’s official website was consulted for clarification. A narrative (descriptive) synthesis was conducted along key themes identified from extracted information such as reported AI tools, functionalities, and stages of use.

Risk-of-bias assessment

The ROBIS tool was used to assess the risk of bias in the included reviews (Supplement A). This tool assesses bias across four domains: study eligibility criteria, identification and selection of studies, data collection and study appraisal, and synthesis and findings. Additionally, ROBIS provides an overall assessment of the risk of bias and limitations based on these domains (26). A high risk of bias indicates lower quality, which could be due to how the review was designed or reported.

Results

Overview of SLR results

In total, 14,226 records were retrieved from electronic literature database searches. After removing 2,354 duplicates, 11,872 records remained for title and abstract screening. The first round of screening excluded 11,178 records, leaving 694 full texts for review. Of these, 103 articles met the eligibility criteria, and an additional 9 eligible articles were identified through the bibliography searches, resulting in a total of 112 articles (Supplement B). These 112 articles represent 111 unique SLRs, as 2 articles reported different outcomes from the same SLR; information on AI tool use was extracted from only one of these. The PRISMA flowchart is shown in Figure 1.

Figure 1.

Figure 1.

PRISMA flow diagram showing the results of the literature search.

Health-related SLRs reporting on the use of AI tools

Among the 111 included studies (112 articles; Table 1), the majority were SLRs with narrative synthesis only (58 articles), followed by SLRs with meta-analysis (32 articles referring to 31 studies), scoping reviews (11 articles), rapid reviews (2 articles), umbrella reviews (2 articles), evidence gap maps (2 articles), an integrative review, a living review, a living review with meta-analysis, a rapid evidence mapping, and a systematic evidence mapping. The most common research areas covered by these reviews were neurology (15 articles), mental health (14 articles), health services research (14 articles referring to 13 studies), public health (10 articles), oncology (8 articles), cardiovascular health (8 articles), immunology (4 articles), and lifestyle research (4 articles).

Table 1.

Characteristics of included studies

Reference a Author affiliations Type of review Topic of review AI tool AI-assisted stage Human-in-the-loop Risk of bias
Identified from database searches
Aali et al. 2020 Academic Scoping review Neurology RobotReviewer Risk of bias assessment Yes High
Agarwal et al. 2021 Academic Systematic review Health service Cochrane RCT Classifier Title/abstract screening Yes Low
Albuquerque et al. 2025 Academic Systematic review Gastroenterology NLP toolkit (developed in Python) b Search strategy development No High
Alfredo Ardisson Cirino Campos et al. 2025 Academic Integrative review Mental health Rayyan Title/abstract screening Yes Unclear
Al-Obeidat et al. 2024 Academic Systematic review and meta-analysis Oncology Rayyan Title/abstract screening Yes Low
Al-Sammarraie et al. 2025 Academic Scoping review Traditional medicine GPT-4 Turbo Data extraction Yes High
Anggreni et al. 2025 Academic Systematic review Endocrinology NVivo Data extraction Yes High
Aucoin et al. 2020 Academic Scoping review Mental health Abstrackr Title/abstract screening Yes High
Aujla et al. 2024 Academic Systematic review and meta-analysis Mental health Nested Knowledge Auto, living semi-automated systematic review platform Title/abstract screening Yes Low
Bagg et al. 2024 Academic Systematic review Neurology Research Screener Title/abstract screening Yes High
Balk et al. 2023a,b Academic Systematic review and meta-analysis Health service Abstrackr Title/abstract screening Yes Low
Baron et al. 2013 Academic Systematic review and meta-analysis Gastroenterology Automated text mining tool b Title/abstract screening Yes High
Bell-Aldeghi et al. 2023 Academic Systematic review Health service Automatic text classification algorithm (developed in Python) b Title/abstract screening Yes High
Bilal et al. 2018 Academic Systematic review and meta-analysis Immunology RobotReviewer Risk of bias assessment Unclear High
Briand et al. 2025 Academic Systematic review (state-of-the-art literature review) Mental health NVivo Data extraction Yes Unclear
Brons et al., 2024 Academic Scoping review Public health ASReview Title/abstract screening Yes High
Brozek et al. 2024 Academic Systematic review Immunology Laser AI Data extraction Yes Low
Buchlak et al. 2022 Academic Systematic review Orthopedics NLP analysis (developed in Python) b Title/abstract screening Yes High
Buchlak et al. 2021 Academic Systematic review Neurology NLP analysis (developed in Python) b Title/abstract screening Yes High
Buchlak et al. 2020 Academic Systematic review Neurology NLP analysis (developed in Python) b Title/abstract screening Yes High
Burger et al. 2025 Academic Systematic review and meta-analysis Mental health ASReview Title/abstract screening Yes Low
Canova et al. 2024 Academic Systematic review Public health ASReview Title/abstract screening Yes Low
Carlson et al. 2023 Academic/Government Systematic evidence mapping Environmental health DoCTER (ML and NLP) b Title/abstract screening Yes High
SWIFT-Active Screener Title/abstract screening Yes
Chamseddine et al. 2022 Academic Systematic review Genetics Semi-automated NLP algorithm b Title/abstract screening Yes High
de Gans et al. 2024 Academic Systematic review Neurology ASReview Title/abstract screening Yes Low
da Silva et al. 2025 Academic Systematic review Neurology Rayyan Title/abstract screening Yes Low
da Silva Mulder et al. 2024 Academic/Government Evidence gap map Health service Rayyan Title/abstract screening Yes Low
Das et al. 2024 Academic Systematic review and meta-analysis Neurology Research Screener Title/abstract screening Yes Low
De Zwart & Ruis, 2024 Academic Systematic review Neurology ASReview Title/abstract screening Yes High
Demirtas Yilmaz. 2025 Academic Systematic review Audiology Rayyan Title/abstract screening Yes High
Ducreux et al. 2025 Academic Systematic review Genetics ASReview Title/abstract screening Yes Low
Feng Q et al. 2025 Academic/Industry Systematic review Obstetrics Grobid - semi-automated workflow Data extraction Yes Unclear
Feng X et al. 2025 Academic Systematic review and meta-analysis Cardiovascular health BioMedGPT-LM-7B Search strategy development Yes Low
Risk of bias assessment Yes
Franzoi et al. 2024 Academic Systematic review Mental health ASReview Title/abstract screening Yes High
García-Torres et al. 2024 Academic Systematic review Health service ChatGPT-4 and 4o Data extraction Yes Low
Ghozy et al. 2024 Academic Systematic review and meta-analysis Neurology AutoLit (Nested Knowledge) Title/abstract screening Yes Low
Data extraction Yes
Glenn et al. 2025 Academic Systematic review Public health ASReview Title/abstract screening Yes Low
Goldkuhle et al. 2018 Academic Rapid review Oncology RobotReviewer Data extraction Yes Low
Risk of bias assessment
Grinzinger et al. 2025 Academic Systematic review Oncology scite.ai, consensus.ai. Search strategy development Yes High
Halamoda‐Kenzaoui et al. 2022 Academic Systematic review/feasibility study Environmental health SWIFT-Review Title/abstract screening Yes High
segmenteR (developed in R) b Full-text screening No
Syntactic parsing tool b Full-text screening No
Data extraction No
Hollands et al. 2019 Academic Systematic review and meta-analysis Lifestyle EPPI-Reviewer 4 Title/abstract screening Yes Low
Hosseini et al. 2023 Academic Systematic review Genetics Semi-automated NLP algorithm b Title/abstract screening Yes High
Hsieh et al. 2024 Academic/Government Systematic review Neurology DistillerSR Title/abstract screening Yes Low
Iaconisi et al. 2024 Academic Systematic review Oncology MySLR (Latent Dirichlet Allocation [LDA] algorithm) Search strategy development Yes High
Screening Yes
Data extraction Yes
Jackson et al. 2022 Academic Systematic review and meta-analysis Lifestyle An automated search strategy developed as part of the Human Behaviour Change Project (ML and NLP) b Search strategy development Yes Low
Jayasundara et al. 2024 Academic Systematic review and meta-analysis Obstetrics Rayyan Title/abstract screening Yes High
Jayawardane et al. 2025 Academic/Government Systematic review Obstetrics Rayyan Title/abstract screening Yes High
Kang et al. 2025 Academic Systematic review and meta-analysis Dentistry Rayyan Title/abstract screening Yes Low
Karagiannis et al. 2019 Academic Rapid review Endocrinology EPPI-Reviewer 4 Title/abstract screening Yes High
Kendall et al. 2025 Academic Systematic review Neurology AutoLit (Nested Knowledge) Data extraction Yes Low
Kim & Cruz, 2022 Academic Systematic review and meta-analysis Mental health Leximancer Data synthesis No High
Kumar et al. 2025 Academic Systematic review and meta-analysis Neuro-oncology AutoLit (Nested Knowledge) Search strategy development Yes Low
Title/abstract screening Yes
Data extraction Yes
Lam et al. 2019 Academic/ Government Rapid evidence mapping Lifestyle SWIFT-Active Screener Title/abstract screening Yes High
SWIFT-Review Data extraction Yes
Landau et al. 2024 Academic Systematic review Health service ChatGPT 3.5 Data extraction Yes Unclear
Liu et al. 2025 Academic Systematic review and meta-analysis Athletic performance ASReview Title/abstract screening Yes Low
Lowe et al. 2021 Academic Systematic review Health service Cochrane RCT Classifier Title/abstract screening Yes Low
Marin et al. 2024 Academic Umbrella review Respiratory medicine Nested Knowledge, SciSpace, Elicit, Perplexity Data extraction Yes Low
McOwiti et al. 2024 Academic Systematic review Health service ASReview Title/abstract screening Yes High
Melinte et al. 2025 Academic Systematic review and meta-analysis Orthopedics Research Rabbitt Supplementary searches (citation searching) Yes Low
Meherali et al. 2025 Academic Evidence Gap Map Climate change EPPI reviewer Data extraction Yes High
Merino-Barbancho et al. 2025 Academic/Industry Scoping review Public health ASReview Title/abstract screening Yes High
Miranda et al. 2021 Academic Systematic review Mental health ASReview Title/abstract screening Yes High
Mushcab et al. 2025 Academic Systematic review Cardio-oncology Elicit Supplementary searches Yes Low
Napolitano et al. 2022 Academic Systematic review COVID-19 Topic modeling tool (developed in R) b Title/abstract screening Yes High
Semantic Scholar Title/abstract screening
ML framework b Title/abstract screening
Nogueira et al. 2025 Academic Systematic review Aesthetic plastic surgery Rayyan Title/abstract screening Yes Low
Noteboom et al. 2024 Academic Systematic review Mental health ASReview Title/abstract screening Yes Low
Olaya-Mira et al. 2025 Academic Systematic review Prosthetics Rayyan Title/abstract screening Yes Unclear
Petrolini-Mateus et al. 2025 Academic Systematic review Public health ChatGPT 4 Title/abstract screening No Low
Pillay et al. 2022 Academic Living review COVID-19 DistillerSR (Daisy AI) Title/abstract screening Yes High
Pinna et al. 2020 Academic Systematic review Mental health Rayyan Title/abstract screening Yes High
Rakhshandehroo et al. 2023 Academic Systematic review Mental health ASReview Title/abstract screening Yes Unclear
Riaz et al. 2021 Academic Living review and meta-analysis Oncology LIvE platform b Citation screening (sub-stage unclear) Yes High
Data synthesis Unclear
Robinson et al. 2024 Academic Scoping review Neurology ChatGPT 4 (Bing chat) Search strategy development Yes High
Sarbout et al. 2025 Academic Systematic review Ophthalmology Elicit Search strategy development Yes High
Shakeri Hossein Abad et al. 2021 Academic Scoping review Public health NLP tools b Search strategy development Yes High
Shemilt et al. 2013
Academic Scoping review Lifestyle EPPI-Reviewer 4 Title/abstract screening Yes Low
Silva et al. 2022 Academic Systematic review Cardiovascular health ASReview Title/abstract screening Yes High
Slebe et al. 2024 Academic Systematic review and meta-analysis Endocrinology ASReview Title/abstract screening Yes Low
Sorrentino et al. 2024a Academic Systematic review Public health Rayyan Title/abstract screening Yes Low
Sorrentino et al. 2024b Academic Systematic review Public health Rayyan Title/abstract screening Yes Low
Spinelli et al. 2023 Academic Systematic review Gastroenterology Rayyan Title/abstract screening Yes High
Steele et al. 2025 Academic Systematic review and meta-analysis Mental health Abstrackr Title/abstract screening Yes Low
Sun et al. 2025 Academic Scoping review Respiratory medicine ASReview Title/abstract screening Yes Low
Susai et al. 2024 Academic Systematic review Public health CADIMA Title/abstract screening Yes High
Talukdar et al., 2024 Academic/Government Systematic review and meta-analysis Nephrology Litmaps Supplementary searches (snowballling) No Low
Teperikidis et al. 2023 Academic Umbrella review Cardiovascular health ChatGPT Search strategy development Yes High
Title/abstract screening Yes
Data extraction Yes
Risk of bias assessment Yes
Data synthesis Yes
Tun et al. 2025 Academic Systematic review Health service Elicit Data extraction Yes High
Valizadeh et al. 2025 Academic Systematic review and meta-analysis Oncology AutoLit (Nested Knowledge) Title/abstract screening Yes Low
Data extraction Yes
Valizadeh et al. 2025 Academic Systematic review and meta-analysis Oncology AutoLit (Nested Knowledge) Title/abstract screening Yes Low
Data extraction Yes
Vallury et al. 2015 Academic Systematic review Mental health Nvivo Full-text screening Yes Unclear
van den Berg et al., 2025 Academic Scoping review Neurology ASReview Title/abstract screening Yes Low
Van Dijk et al. 2024 Academic Systematic review Cardiovascular health ASReview Title/abstract screening Yes Low
Visser et al. 2025 Academic Systematic review Health service ASReview Title/abstract screening Yes Low
Vizcarra et al. 2024 Academic Systematic review Neurology Python and ChatGPT-4 Title/abstract screening Yes Unclear
Voorn et al. 2025 Academic Systematic review and meta-analysis Geriatrics ASReview Title/abstract screening Yes Low
Wen et al. 2025 Academic Systematic review and meta-analysis Hepatology ASReview Title/abstract screening Yes Low
Westendorp et al. 2023 Academic Systematic review Health service ASReview Title/abstract screening Yes Low
Yamikan et al. 2025 Academic Systematic review Cardiovascular health Rayyan Title/abstract screening Yes Low
Yappalparvi et al. 2025 Academic Systematic review and meta-analysis Cardiovascular health AutoLit (Nested Knowledge) Title/abstract screening Yes High
Data extraction Yes
Yazicioglu et al. 2025 Academic Systematic review Health service Rayyan Title/abstract screening Yes Low
Zamantakis et al. 2024 Academic Systematic review Public health Semi-automated text mining and natural language processing (custom) Title/abstract screening No Unclear
Zhu et al. 2023 Academic Scoping review Health service ASReview Title/abstract screening Yes High
Identified from hand searches
Crossingham et al. 2021 Academic/ Government Systematic review and meta-analysis Immunology Cochrane RCT Classifier Title/abstract screening Yes Low
Eun et al. 2021 Academic Systematic review and meta-analysis Cardiovascular health ML approach (developed in Python) b Title/abstract screening Yes High
Foulquier et al. 2018 Academic Systematic review Immunology BIBOT (NLP; developed in Python) b Title/abstract screening No High
Gaskins et al. 2021 Academic Systematic review Neurology Rayyan Title/abstract screening Yes High
Giummarra et al. 2020 Academic Systematic review Mental health Abstrackr Title/abstract screening Yes Low
Wordstat and QDA Minder Full-text screening Yes
Rogers et al. 2020 Academic Systematic review and meta-analysis Oncology Rayyan Title/abstract screening Yes Low
Viner et al. 2022 Academic Systematic review COVID-19 EPPI-Reviewer 4 Title/abstract screening Yes High
Xiong et al. 2018 Academic Systematic review and meta-analysis Cardiovascular health ML approach (developed in R) b Title/abstract screening Yes High
Yamamoto et al. 2021 Academic Systematic review and meta-analysis Nephrology RobotAnalyst Title/abstract screening Yes High
a

The articles identified in the systematic literature review are listed in Supplement B.

b

Custom tools.

AI, artificial intelligence; ML, machine learning; NLP, natural language processing; RCT, randomized controlled trial.

The earliest reviews reporting the use of AI tools were published in 2013, with an increasing number of AI-assisted reviews identified over time (Figure 2). Among the 112 included articles (111 unique SLRs), 91.1 percent were published since 2020. For 2025, 38 AI-assisted SLRs had been published as of September 2025. Of the 112 articles, 103 were authored solely by researchers from academic institutions, 7 involved collaborations between academia and government organizations, and 2 were collaborations between academia and the pharmaceutical industry (Table 1).

Figure 2.

Figure 2.

Number of health-related reviews reporting on the use of AI over the years.

Although the findings from the included reviews were not synthesized in the current study, the ROBIS tool was used to assess the quality of AI-assisted reviews. Among the 111 included studies, 51 (45.9 percent) had a high risk of bias, 51 studies (45.9 percent) had a low risk of bias, and 9 studies (8.1 percent) had an unclear risk of bias (Supplementary Table 3).

Adoption of AI in SLRs and usage trends

In total, 134 implementations of AI were identified across the 111 included reviews. Within these, forty-five distinct AI tools were used, comprising twenty-nine publicly available software-based tools and sixteen custom tools developed by the article authors.

AI tools were used most frequently for title and abstract screening (eighty-eight instances, including two studies in which the screening stage was unspecified), followed by data extraction (twenty-one instances), search strategy development (ten instances), risk-of-bias assessment (five instances), full-text review (four instances), data synthesis (three instances), and supplementary searches (three instances) (Figure 3).

Figure 3.

Figure 3.

Use of AI software across the different stages of an SLR.

The most frequently used AI software was ASReview (twenty-four reviews), followed by the ML functionality in Rayyan (eighteen reviews), Autolit (Nested Knowledge; eight reviews) and EPPI-Reviewer (five reviews), all of which were used for title and abstract screening (EPPI-Reviewer was also used for data extraction and AutoLit was also used for data extraction and search strategy development). In addition to tools specifically designed for SLRs, OpenAI’s generative AI models (such as ChatGPT and other GPT-based systems) were used for multiple tasks in eight separate reviews, including search strategy generation, title and abstract screening, data extraction, risk-of-bias assessment, data synthesis, and report writing. The remaining AI software tools were each used in five or fewer studies (Figure 4). Although some authors who used custom tools shared their code, many of these tools are likely to be inaccessible to the public.

Figure 4.

Figure 4.

AI software used in published health-related reviews.

Search strategy development

AI tools were used for search strategy development in twelve instances. Three studies applied LLMs (two using ChatGPT and one using BioMedGPT-LM-7B) and five studies employed platform-based tools such as Elicit, Nested Knowledge, MySLR, and scite.ai/consensus.ai to identify relevant concepts and expand terminology. The remaining three studies used custom NLP- or ML-based tools, including an automated search strategy developed as part of the Human Behaviour Change Project.

Title/abstract screening

Title and abstract screening was the most common stage for use of AI tools, with eighty-eight instances, including two studies in which the screening stage (title/abstract or full text) was unspecified. Various software-based tools were used for screening, with ASReview being the most frequently used (twenty-four instances). The primary AI feature applied during title and abstract screening was active learning–based relevance prediction, in which the algorithm continuously reprioritized records based on reviewer feedback to optimize efficiency and accuracy. Similarly, most custom tools were developed for screening. The main features of these tools included relevance prediction and topic modeling. Some custom tools were also designed to calculate scores based on metrics, such as the presence and frequency of keywords, to determine study relevance.

Full-text screening

AI-assisted full-text screening was identified in four instances. In total, three software-based text analysis tools – Nvivo, Wordstat, and QDA Miner – were used to search for keywords and synonyms indicating relevance to the research question. In one review, the authors developed a custom article segmentation tool that extracted the methods and results sections from full-text articles. A syntactic parsing tool was then applied to identify studies containing predefined keywords, enabling full automation of citation screening in that study.

Supplementary searches

AI was used for supplementary searches in three instances, with Research Rabbit, Elicit, and with Litmaps. In the SLRs that used Research Rabbit and Litmaps, the AI features of these tools were applied to identify articles related to those retrieved through the main database searches. When Elicit was used, it employed the same search terms as those used in the main database searches.

Data extraction

AI was used for data extraction in twenty-one instances, with AutoLit (Nested Knowledge) and GPT-based models being the most frequently employed (seven and four instances, respectively). The most utilized AI feature was NLP–based automated data extraction, in which LLMs parsed full-text articles to identify and populate structured variables such as study characteristics, interventions, and outcomes. In one study, a custom syntactic parsing tool used for full-text screening was also applied in data extraction to collect information related to the research question.

Risk-of-bias assessment

AI was used for risk-of-bias assessment in five instances. In three studies, RobotReviewer, a software-based tool, was used to assess risk of bias in RCTs. In another study, ChatGPT was utilized with prompts based on AMSTAR 2.0, a risk-of-bias assessment tool for systematic reviews. In the fifth study, BioMedGPT-LM-7B, a generative AI model trained on Cochrane-rated RCTs, was used to automatically assess risk of bias.

Data synthesis

AI was used for data synthesis in three instances. In one study, Leximancer, a software-based tool, was used for qualitative (thematic) data synthesis. Another software-based tool, an ML-based RCT classifier, was integrated into a living review platform (LIvE) and applied during the data synthesis step. In the third study, ChatGPT was explored for data synthesis and report writing.

Functionality of current AI tools

In the identified studies, none of the AI tools operated fully autonomously. Human reviewers played a critical role at all SLR stages, with AI tools primarily serving as support systems. (Supplementary Table 4). For title and abstract screening, most software-based AI tools required training with manually labeled records before implementation. Following this, priority screening was applied, for which the most relevant records were prioritized for human reviewers to assess. After this step, either all remaining records were manually screened or the authors defined a stopping rule (i.e., the number of consecutive exclusions required to stop manual screening). For data extraction and risk-of-bias assessment, human reviewers were involved in complementing or verifying extracted data and assessment results. However, thematic data synthesis with Leximancer was conducted without human intervention. Custom AI workflows also required human participation at various stages, including training, manual screening, and verification, similarly to software-based tools.

Adoption of AI in HTAs

As of October 2025, few HTA agencies had issued formal guidance on the use of AI tools for SLRs. Only the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany (17), the National Institute for Health and Care Excellence (NICE) in the United Kingdom (18), and Canada’s Drug Agency (CDA-AMC) (15)) have published official guidance on the potential application of AI or ML methods in the evidence-generation process (Supplementary Table 5). In 2019, EUnetHTA published a detailed guideline for information retrieval for SLRs and HTAs that mentioned early references to text-analytic approaches for search-term identification (16). The JBI Manual for Evidence Synthesis and the Cochrane Handbook have included recommendations on the use of AI at different stages of the review process (23).

Search strategy development

IQWiG explicitly supports the use of text analysis and ML methods to aid in developing search strategies (17), and NICE’s position statement (18) acknowledges that AI and LLMs can assist with search strategy generation. EUnetHTA’s information retrieval guideline also refers to text-analytic approaches for identifying search terms (16). Similarly, the Cochrane Handbook recommends text-mining and frequency-analysis techniques to identify relevant terms and concepts (23).

Citation screening

IQWiG’s latest General Methods note that validated classifiers and other ML approaches may assist in title and abstract screening (17), whereas NICE recognizes that AI tools can help to classify study designs and prioritize records for review (18). EUnetHTA refers to screening platforms such as Covidence, Rayyan, and EPPI-Reviewer that can facilitate reviewer collaboration and documenting the screening process, although it does not provide AI-specific recommendations (16). The Cochrane Handbook explicitly describes the Cochrane RCT Classifier and Cochrane Crowd as validated tools that support semiautomated RCT identification and highlights the value of ML and text-mining to streamline screening workflows (23).

Data extraction and risk risk-of of-bias assessment

The Cochrane Handbook discusses the potential use of NLP and ML tools to automate data extraction and risk-of-bias assessment but does not recommend specific systems owing to their limited validation at the time of publication (23). IQWiG, NICE, and EUnetHTA have not yet provided formal recommendations on AI-assisted data extraction or risk-of-bias assessment in their methodological guidance.

Advantages and disadvantages of AI tools

One key advantage of AI tools for title/abstract screening, data extraction, and risk-of-bias assessment was substantial time savings (Supplementary Table 6). AI-assisted screening reduced the manual workload by limiting the number of studies requiring human review, particularly during citation screening. Reviewers also noted that AI tools generally produced accurate outputs and improved reviewer performance by increasing objectivity.

However, limitations were also noted. Some studies reported AI errors and raised concerns that relevant records might be missed during screening. Reviews also highlighted the absence of validated stopping rules for priority screening, increasing the risk of omitting eligible studies if manual screening stopped too early. Rank-order bias was another concern, as the ranking of records could influence inclusion decisions, although some reviews suggested that alternative validation approaches may help to mitigate this risk.

Discussion

To the authors’ knowledge, this study is the first to systematically assess the use of AI tools in healthcare-related SLRs, addressing three key objectives: (i) quantifying published SLRs reporting use of AI tools; (ii) identifying AI tools used at each SLR stage and their functionalities; and (iii) assessing whether HTA agencies accept or recommend AI tools. Across 111 identified SLRs, 45 distinct AI tools were reported, most frequently used for title and abstract screening. Human oversight remains critical, as no studies used fully autonomous AI. Few HTA agencies have issued formal guidance on AI in SLRs (15–18) suggesting limited current acceptance for HTA decision making. These findings highlight the growing role of AI in evidence synthesis and the need for further evaluation of its integration into HTA processes. Notably, the use of AI tools in SLRs consistently incorporated human oversight, reflecting current HTA positions that automation should support, rather than replace, human expert judgment.

AI appeared in SLRs in 2013, with over 90 percent of AI-assisted reviews published since 2020. This trend may reflect the influence of PRISMA 2020 guidance, which introduced requirements to report automation tools in study selection and data-collection processes (22). Among the 111 included reviews, AI was mostly used in the title and abstract screening stage (88 instances, including 2 studies in which the screening stage was unspecified), but fewer studies applied AI for data extraction (21 instances), full-text review (4 instances), risk-of-bias assessment (5 instances), literature searches (10 instances), data synthesis (3 instances), and supplementary searches (3 instances). In total, twenty-nine publicly available software-based tools and sixteen custom-built tools were identified. However, reporting inconsistencies and indexing limitations likely mean these studies represent a fraction of healthcare-related SLRs, and some tools may also be used internally without disclosure. Insufficient guidance on AI use in systematic reviews may hinder transparent reporting, as evidenced by inconsistencies observed in peer-reviewed publications. For HTA processes, a lack of clarity in this regard could limit reproducibility and confidence in evidence generation, underscoring the need for clear standards. Emerging guidelines, such as ELEVATE-GenAI for reporting LLM use in Health Economics and Outcomes Research (27), highlight growing interest in standardizing AI reporting in health-related research. Most reviews were conducted by academic or research institutions, with only a small proportion involving collaborations with government or industry partners. This indicates that AI applications in systematic reviews remain largely driven by the academic research community.

AI can automate repetitive and time-consuming SLR tasks, allowing researchers to focus on higher-level tasks. Most AI tools employed a human-in-the-loop approach, supporting rather than replacing human reviewers. Although generative AI and agent-based systems are advancing, none of the identified studies used fully autonomous AI, consistent with HTA expectations (18). Reported limitations included potential errors, missed studies, and data reliability concerns, reinforcing the need for human oversight. These findings align with previous research on AI use highlighting challenges related to data validity, transparency, and systemic biases (28;29). Nonetheless, AI offers benefits in terms of efficiency and consistency by reducing variability in subjective judgment (11), identifying patterns and insights that may not be immediately apparent to human reviewers, and minimizing human bias and fatigue. Overall, when used to complement human expertise in SLRs, AI should enable faster high-quality reviews that ultimately benefit HTA decision making (11;30).

Although CDA-AMC, IQWiG, NICE, EUnetHTA, JBI and Cochrane have recommended several AI functionalities for SLRs (15–18), formal HTA guidelines remain limited. Barriers to adoption of AI in HTA include data quality concerns, limited technical expertise, infrastructure constraints, regulatory uncertainty, and ethical or policy issues (28;29).

The future of AI in SLRs and HTAs is likely to expand with advancements in AI technologies and the development of LLMs. Although current AI tools are mainly designed for title and abstract screening, future developments will likely assist with full-text review, data extraction, and risk-of-bias assessment. Generative AI can already summarize large volumes of text, generate insights, and draft sections of reports (31), supporting dynamic methodologies such as in living reviews and living HTA. AI can also manage increasing workloads driven by external circumstances. For instance, the implementation of the Joint Clinical Assessment process in January 2025 (7;19;20) may drive increased AI involvement in HTA-related evidence synthesis, particularly in identifying PICO criteria and conducting indirect treatment comparisons. The integration of AI into SLRs for HTA could ultimately accelerate timelines and expedite patient access to treatments.

The findings of this comprehensive assessment of AI use in health-related SLR publications build on prior research, such as Blaizot et al. (21), which examined a similar topic but covered a narrower scope. Compared with Blaizot et al., this study identified a greater number of relevant articles, not only because of a later search date but also because of the broader inclusion of AI applications beyond screening. This study also extends a review by Khalil et al. (32) by incorporating the emerging generative-AI period and evaluating their relevance to HTA guidance and practice.

Several limitations should be noted. First, a single reviewer conducted the screening process, increasing the risk of bias. However, this limitation was partially mitigated by adhering to standard SLR methodology and by validating included studies against prior SLRs. Second, the literature search was limited to English-language publications, which may have excluded some relevant studies; however, our comprehensive search of HTA websites, including fifty-three members of INAHTA and EUnetHTA, would have ensured that the key international guidance on AI use in SLRs was captured regardless of the primary language of publication. Third, only studies that explicitly mentioned AI in the title or abstract were included for full-text review, potentially excluding eligible studies that referenced AI use only in the full-text. However, this is a standard limitation of SLRs because title and abstract screening is a widely accepted approach for managing large search results. Fourth, half of the included studies had a high or unclear risk of bias as measured by the ROBIS tool. However, this was expected because ROBIS requires at least two human reviewers for screening, data extraction, and risk-of-bias assessment. Yet, in many cases, AI tools replaced one or more human reviewers, and the extent of human involvement in these stages was often unclear. Finally, given the rapid evolution of AI tools, it is also possible that new AI-assisted SLRs have been conducted since September 2025, when the searches were completed.

Conclusions

This study found that AI was reported as used in 112 articles about 111 unique health and medical research SLRs. Although commercial and custom tools now support all stages of SLR development, most commonly title and abstract screening, the adoption rate remains low, and human involvement remains critical. AI use in SLRs is increasing, with over 90 percent of AI-assisted reviews identified published since 2020. Few HTA agencies have provided guidelines on the use of AI tools for SLRs, suggesting limited current acceptability in HTA decision making. As AI technologies evolve, further research is needed to assess performance and reliability to inform guideline updates. Collaborative consensus exercises involving HTA agencies and methodological experts could also help to refine existing guidance and develop standardized criteria for validating AI tools in SLRs. These developments will contribute to more timely and efficient healthcare decision making, potentially accelerating patient access to treatments.

Supporting information

Abogunrin et al. supplementary material

Abogunrin et al. supplementary material

DOI: 10.1017/S0266462326103535.sm001

Acknowledgments

Medical writing support was provided by Obaro Evuarherhe, PhD, and Gemma Carter, PhD, of Oxford PharmaGenesis, Oxford, UK, with funding from F. Hoffmann-La Roche Ltd.

Supplementary material

The supplementary material for this article can be found at http://doi.org/10.1017/S0266462326103535.

Funding statement

This work was funded by F. Hoffmann-La Roche, Basel, Switzerland (grant number: N/A).

Competing interests

Y.L. was an employee of Roche when the research was conducted. S.A. and C.Z. are employees of F. Hoffman-La Roche Ltd and own F. Hoffman-La Roche Ltd. stocks.

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Supplementary Materials

Abogunrin et al. supplementary material

Abogunrin et al. supplementary material

DOI: 10.1017/S0266462326103535.sm001

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