Health Technology Assessments

What are they and how are they produced?

Karen Ritchie, Senior Health Services Researcher

What is a Health Technology?

Any intervention that may be used topromote health, to prevent, diagnose or treat disease or for rehabilitation

or long-term care.

The term encompassesdrugs, devices, clinical procedures and

health care settings

Health Technology Assessment(INAHTA, 2000)

Health Technology Assessment (HTA)is a multi-disciplinary field of policy analysis,

which studies the medical, social, ethical and economic

implications of development, diffusion and use of health technology.

Health Technology Assessments

Completed• Organisation of services for diabetic

retinopathy screening• PET imagine in cancer management• Prevention of relapse in alcohol dependence• Troponin testing in acute coronary syndromes• Ultrasound scanning in early pregnancy

Current• The use of B-type natriuretic peptides in the

investigation of heart failure• The use of alcohol hand gel to increase hand

washing compliance and reduce healthcare associated infection rates

Health Technology Assessment (HTA)

Health Technology Assessment

Scientific evidence

Views of health service

users

Health professionals’

judgement

NHSQIS Advice

Economic EvaluationModel of what would happen to Scottish

patients in the long-term, taking account of costs

and benefits

OrganisationalIssues

What’s needed to use the technology in a

quality assured mannerStaffing, legal issues, etc

Patient IssuesPatient’s needs and preferences

Psychological, social and ethical issues

Clinical effectiveness Does the technology work in clinical practice

and is it safe?

Health Technology Assessment (HTA)

OrganisationalIssues

What’s needed to use the technology in a

quality assured mannerStaffing, legal issues, etc

Health Technology Assessment (HTA)

Organisational IssuesSurvey

• Routine scan programme– 13 units offer first trimester scan only– 3 units offer a second trimester scan only– 21 units offer two scans

• Variation reported in:– content and timing of scans– staffing and training– equipment used– consent procedures

Clinical effectiveness Does the technology work in clinical practice

and is it safe?

Health Technology Assessment (HTA)

Clinical Effectiveness

• Evaluation of benefit to risk using

• outcome measures of importance to patients in a

• standard clinical setting

Literature search

• Initial searches to identify HTAs, systematic reviews and evidence-based guidelines

• Key health-related databases (e.g. Medline, Embase)

• Web sites of relevant organisations (e.g. patient groups, professional bodies)

• Ongoing research (e.g. MRC Funded Research, National Research Register)

Clinical Effectiveness

• Secondary literature– fetal viability– multiple pregnancies– gestational age

• Primary literature– fetal abnormalities

Search methodology

• Question broken down into concepts- Population AND intervention AND

outcome- e.g. Pregnancy AND ultrasound AND

morbidity

Initial results

• Pregnancy AND ultrasound = 32,000 records (Medline)

• Records filtered:– RCTs– Diagnostic accuracy– Outcomes

Initial results

• 2446 RCTs identified

• 315 selected on title and abstract

• 2923 diagnostic accuracy records

• 373 selected on title and abstract

Patient IssuesPatient’s needs and preferences

Psychological, social and ethical issues

Health Technology Assessment (HTA)

Issues for pregnant women

Methods• Review of literature• 2 expert interviews• Focus groups

– deprived, low income mothers– teenage mothers– middle income, urban mothers– middle income, rural mothers

Economic EvaluationModel of what would happen to Scottish

patients in the long-term, taking account of costs

and benefits

Health Technology Assessment (HTA)

Economic evaluation has been defined as

‘ the comparative analysis of alternative courses of action in terms of both their costs and consequences’ (Drummond & McGuire, 2001)

It is concerned with choices about how to use scarce resources

Economic evaluation

Economic Modelling

ModelCohort studies

Observational studies

Clinical trialsEpidemiologyPatient pathways

Economic dataCosts of screeningCosts of outcomes

Scanning Strategies

        

Strategy 1st trimester scan

1st trimester markers

2nd trimester markers

2nd trimesterscan

1 NT Y   Y

2 NT Y   N

3 NT Y AFP Y

4 NT Y AFP N

5 Booking - double test Y

6 Booking - double test N 

Strategy Anomalies detected

Iatrogenic losses

Cost

10 NT scan + 20 scan

176 8 £151

10 NT scan 71 8 £107

10 scan + blood test + 20 scan

176 16 £147

10 scan + blood test

87 16 £104

Recommendations

• First trimester scan should be offered to all

– fetal viability, multiple pregnancy, gestational age

• First trimester screen for chromosomal abnormalities including NT measurement

• All women should be offered a second trimester anomaly scan

Issues for women

I don’t think they give you enough scans.

I think it’s lovely, I could lie there all day watching this little thing.

I don’t think they explained it

enough.

My doctor just booked the appointment…you just went ahead and that’s what you did. Nobody said did you want to do it?

Recommendations

• Appropriate patient information prior to ultrasound scan

• Information should included conditions identifiable and risks of invasive tests

• Time should be available for discussion

Aim and Legal Status of Advice

NHSScotland should take account of advice and evidence from the NHS Quality Improvement Scotland

and

ensure that recommended drugs or treatments are made available to meet clinical need

Principles of Health Technology Assessment

Global Evidence

National Advice

Local/National Implementation

E N G L A N D

ORKNEY

WESTERNISLES

GRAMPIAN

S T R A T H C L Y D E

TAYSIDE

FIFECENTRAL

LOTHIAN

BORDERS

DUMFRIES &GALLOWAY

HIGHLAND

Firthof

Clyde

A T L A N T I C

O C E A N

Edinburgh

Kirkwall

Stornoway

Inverness

Aberdeen

Cupar

Stirling

Glasgow

NewtownSt. Boswells

Dumfries

Dundee

N

SCOTLAND60 MI.30150

0 3015 60 KM.

Regional Centers - Capital -

For more information on Health Technology Assessments and the other

work of NHS QIS:

nhshealthquality.org