2. Key themes in health care
• The accelerating pace of health technology
• The interplay of science and judgement at
all levels of health care
• The need for rigour in decision-making
3. • Diagnostic technologies
Radio immunoassay
Flexible endoscopy
Computerised tomography
Diagnostic ultrasound
• Therapeutic technologies
1,106 new drugs marketed 1970-92
New devices (pacemakers, stents…..)
New surgical procedures (transplantation,
laparoscopy…)
4. Prescriptions for prevention and treatment of
all circulatory diseases, 1981-2000, England
0
20
40
60
80
100
120
140
1980 1985 1990 1995 2000 2005
Year
Prescriptions
(millions)
Drugs
5. Trial publications and prescriptions for lipid
lowering drugs
0
2,000
4,000
6,000
8,000
10,000
12,000
1980 1985 1990 1995 2000 2005
Year
Prescriptions
(thousands)
4S
CARE
WOSCOPS
(statins
£308m)
7. What is HTA for?
• To supply the evidence base for those who
plan, manage, provide or use health services
in making decisions
• HTA does not make or determine the
decisions
• HTA is needed at every level of health care
8. • Assessment is a research activity and produces
generalisable new knowledge
• ‘Appraisal’ applies that knowledge to specific
local circumstances:
– Applicability
– Social values
– Local priorities
– Local resources
Responding to the challenge of new technologies
9. •Clarity (and accountability) of function
•Application of the right skills and
competencies
•Assessments are transferable and replicable
Why Separate Assessment and Appraisal?
12. A methodology of appraisal
The principles underlying decision-making
have received less rigorous attention than
the science, e.g:
• Equity?
• Priority?
• Efficiency?
• Individual preference/societal values?
13. HTA in Support of Appraisal
• NICE
– 40-50 TARs per year
• NSC
– Systematic reviews on screening for prostate
cancer, Down’s, HPV in cervical screening
– RCTs on same topics
• NSCAG
– ECMO trial; ventricular assist devices
14. 1. Science informs, but does not dictate,
decisions in health care
2. The scientific challenges are:
– Synthesising evidence validly
– Quantifying uncertainty
– Communicating probabilities to those making
decisions
17. Future issues for better decision-making
• Assessment
– Synthesis from diverse study designs
– Preserving transparency
– Growing the research capacity
• Appraisal
– Adapting to rapidly moving evidence
– Developing and ‘selling’ explicit principles
– Locating decisions at the right level
