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Health technology assessment in England and Wales

Published online by Cambridge University Press:  23 April 2004

Andrew Stevens  and
Ruairidh Milne
Andrew Stevens
Affiliation:
University of Birmingham
Ruairidh Milne
Affiliation:
University of Southampton
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Abstract

In this study, we describe the current state of the Health Technology Assessment (HTA) system in England and Wales. This system rests on a distinction between assessment and appraisal and has three main strands: researcher-led HTA, the research and development program, and the HTA-NICE (National Institute for Clinical Excellence) process. We outline the pressures for HTA and how it has evolved in the British National Health Service. We discuss how HTA priorities are chosen, how HTA information is collected and assessed, how HTA evidence is used, and we make some observations about its impact. In our discussion, we consider some limitations of the HTA system, its possible divergence from evidence-based health care, its centralization, and some of the key challenges for managing HTA-driven policy. But we remain hopeful that HTA can contribute to better and more explicit decision-making within England and Wales.

Keywords

Health technology assessmentEngland and Wales
Type
Research Article
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 1 , January 2004 , pp. 11 - 24
Copyright
© 2004 Cambridge University Press

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References

Alderson P, Bunn F, Lefebvre C, et al. 2002 Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev. (1): CD001208.Google Scholar
Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. 1992 A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA. 268: 240– 248.Google Scholar
Best L, Stevens A, Colin-Jones D. 1997 Rapid and responsive health technology assessment: The development and evaluation process in the South and West region of England. J Clin Effect. 2: 51– 56.Google Scholar
Chamberlain J, Melia J, Moss S, Brown J. 1997 The diagnosis, management, treatment and costs of prostate cancer in England and Wales. Health Technol Assess. 1: 1– 53.Google Scholar
Chase D, Milne R, Stein K, Stevens A. 2000 What are the relative merits of the sources used to identify potential research priorities for the NHS HTA program? Int J Technol Assess Health Care. 16: 743– 750.Google Scholar
Cochrane A. 1972 Effectiveness and efficiency: Random reflections on the health service. Leeds: Nuffield Provincial Hospital Trust;
Dent TH, Sadler M. 2002 From guidance to practice: Why NICE is not enough. BMJ. 324: 842– 845.Google Scholar
Department of Health. 2000 The NHS Plan. A plan for investment, A plan for reform. London: Department of Health;
Department of Health. Getting access to DH/NHS R&D Research findings. Available at: http://www.doh.gov.uk/research/rd3/information/findings.htm. Accessed: July 13, 2002.
Department of Health. National Specialist Commissioning Advisory Group. Available at: http://www.doh.gov.uk/nscag. Accessed: July 13, 2002.
Department of Health. New statutory obligations for NHS to fund treatments recommended by NICE. Available at: http://tap.ccta.gov.uk/doh/intpress.nsf/page/2001-0599?Open Document.
Department of Health. 1991 A research and development strategy for the NHS. London: Department of Health;
Department of Health. 1992 Assessing the effects of health technologies: Principles, practise, proposals. London: Department of Health;
Early Breast Cancer Trialists' Collaborative Group. 1995 Effects of radiotherapy and surgery in early breast cancer: an overview of the randomised trials. N Engl J Med. 333: 1444– 1455.
Economist. 2001 World statistics compendium 2002. London: Economist 2001;
Eddy D. 1999 Doctors, economics and clinical practice guidelines: Can they be brought together. London: Office of Health Economics;
Enkin MW. 1998 Foreword. Randomised controlled trials. London: BMJ Books vii– x.
Evidence-based medicine. 1992 A new approach to teaching the practice of medicine. Evidence-based medicine working group. JAMA. 268: 2420– 2425.
Freemantle N, Harvey EL, Wolf F, Grimshaw JM, Grilli R, Bero LA. 2000 Printed educational materials: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. (2): CD000172.Google Scholar
Gabbay J, Kerridge L, Milne R, Stein K. 2001 The NHS R&D health technology assessment program. Research and development for the NHS: Evidence, evaluation and effectiveness. Abingdon, Oxon: Radcliffe Medical Press; 141– 162.
General Medical Council. Maintaining Good Medical Practice. Available at: http://www.gmc-uk.org/standards/MGMP.HTM.
Glover JA. 2002 The incidence of tonsillectomy in school children. Proc R Soc Med. 1938. pp. 1219– 1236.Google Scholar
Halligan A, Donaldson L. 2001 Implementing clinical governance: turning vision into reality. BMJ. 322: 1413– 1417.Google Scholar
Hoare J. 1992 “Tidal Wave”—New technology, medicine and the NHS. London: King's Fund, IHSM, MAS;
House of Lords Select Committee on Science and Technologies. 1988 Priorities in medical research. London: HMSO;
Hunter DJ. 1995 Rationing: The case for “muddling through elegantly.” BMJ. 311: 811.Google Scholar
McKeown T. 1979 The role of medicine. Oxford: Blackwell;
Medical Devices Agency. Medical Devices Agency. Available at: http://www.medical-devices.gov.uk/. Accessed: July 13, 2002.
Medicines Control Agency. Welcome to the Medicines Control Agency. Available at: http://www.mca.gov.uk/. Accessed: July 13, 2002.
Milne R, Hicks N. 1996 Evidence-based purchasing [EBM Note]. Evidence-Based Med. 101– 102.Google Scholar
Ministry of Health. 1944 A national health service. London: HMSO; Report No.: Cmnd 6502.
National Electronic Library for Health. 2001 Clinical evidence (issue 7). London: BMJ Publishing Group;
National Institute for Clinical Excellence. 2002 Beta interferon and glatiramer acetate for the treatment of multiple sclerosis. London: National Institute for Clinical Excellence; Report No.: Technology Appraisal Guidance No. 32.
National Institute for Clinical Excellence. Available at: www.nice.org.uk. Accessed: July 13, 2002.
National Statistics. 2002 Social trends No.: 32. 2002 edition. London: Stationery Office
NCCHTA. Health technology assessment. A national R&D program for the NHS. Available at: www.ncchta.org. Accessed: July 13, 2002.
NCCHTA. NHS R&D Health technology assessment program. Publications page. Available at: http://www.hta.nhsweb.nhs.uk/htapubs.htm. Accessed: July 13, 2002.
NHS Centre for Reviews and Dissemination. 2001 Undertaking systematic reviews of research on effectiveness. York: University of York; Report No.: CRD Report Number 4 (2nd edition).
NHS Centre for Reviews and Dissemination. Database of Abstracts of Reviews of Effectiveness (DARE). Available at: http://agatha.york.ac.uk/darehp.htm. Accessed: July 13, 2002.
Oliver S, Milne R, Bradburn J, et al. 2001 Investigating consumer perspectives on evaluating health technologies. Evaluation. 7: 468– 486.Google Scholar
Oliver S, Milne R, Bradburn J, et al. 2001 Involving consumers in a needs-led research program: A pilot project. Health Expect. 4: 18– 28.Google Scholar
Oxman AD, Thomson MA, Davis DA, Haynes RB. 1995 No magic bullets: A systematic review of 102 trials of interventions to improve professional practice. CMAJ. 153: 1423– 1431.Google Scholar
Payne N, Akehurst R, Beard S, et al. 1999 Supporting purchasing in acute specialities in the Trent region. In: Davies HTO, Tavakoli M, Malek M, Neilson AR, eds. Controlling costs: Strategic issues in health care management. London: Ashgate Publishing Ltd; 118– 130.
Public Health Resource Unit of NHS. NHS Economic Evaluation Database (NHS EED). Available at: http://agatha. york.ac.uk/nhsdhp.htm. Accessed: July 13, 2002.
Public Health Resource Unit of NHS. Welcome to CASP. Available at: http://www.phru.org.uk/~casp/index.htm. Accessed: July 13, 2002.
Raftery J, Barrett B, Packer C, Stevens A. 2001 The impact of technology on costs, The National Horizon Scanning Centre, in Health Trends Review. Proceedings of a conference held at the Barbican Centre, London on 18 and 19 October 2001, HM Treasury, November.Google Scholar
Raftery J. 2001 NICE: Faster access to modern treatments? Analysis of guidance on health technologies. BMJ. 323: 1300– 1303.Google Scholar
Rawlins MD. 2001 The failings of NICE. Reply from chairman of NICE. BMJ. 322: 489.Google Scholar
Royal Commission on the National Health Service. 1979 Report of the Royal Commission on the National Health Service (1979), Cmd7615. London: The Stationery Office;
Selley S, Donovan J, Faulkner A, Coast J, Gillatt D. 1997 Diagnosis, management and screening of early localised prostate cancer. Health Technol Assess. 1: 1– 96.Google Scholar
Stevens A, Raftery J. 1994 Health care needs assessment (2 vols). In: Stevens A, Raftery J, eds. Oxford: Radcliffe Medical Press; 1311.
Stevens A, Milne R. 1998 A knowledge-based health service: How do the new initiatives work? J R Soc Med. 91 (Suppl 35): 26– 31.Google Scholar
Technology Change in Health Care (TECH) Research Network. 2001 Technological change around the world: Evidence from heart attack care. Health Aff (Millwood). 20: 25– 42.
The Cochrane Library. The Cochrane Library. Available at: http://www.update-software.com/cochrane/. Accessed: July 13, 2002.
The European Agency for the Evaluation of Medicinal Products. The European Agency for the Evaluation of Medicinal Products. Available at: http://www.emea.eu.int/. Accessed: July 13, 2002.
The National Research Register. The National Research Register. Available at: http://www.update-software.com/National/. Accessed: July 13, 2002.
Tröhler U. 2000 “To improve the evidence of medicine.” The 18th century British origins of a critical approach. Edinburgh: Royal College of Physicians of Edinburgh;
Tunstall-Pedoe H, Vanuzzo D, Hobbs M, et al. 2000 Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations. Lancet. 355: 688– 700.Google Scholar
UK National Screening Committee. UK National Screening Committee. Available at: http://www.nsc.nhs.uk/. Accessed: July 13, 2002.
University of Birmingham. National Horizon Scanning Centre. Available at: http://www.publichealth.bham.ac.uk/horizon. Accessed: July 13, 2002.
US Congress, OoTA. Identifying health technologies that work. Searching for the evidence. 1994 Washington DC: Government Printing Office; Report No.: OTA-H-6808.
Wanless D. Securing our future health: Taking a long-term view. Available at: http://www.hm-treasury.gov.uk/ consultations and legislation/wanless/consult wanless index. cfm. Accessed: July 13, 2002.
Wilson B, Thornton JG, Hewison J, et al. 2002 The Leeds University Maternity Audit Project. Int J Qual Health Care 14: 175– 181.Google Scholar
Winyard G. Population screening for prostate cancer. Available at: http://www.nsc.nhs.uk/pdfs/el9712.pdf. Accessed: July 13, 2002.