Post on 21-Dec-2015
Assessment and Appraisal:Fundamental Aspects of Health Care
Kent Woods
Director, NHS Health Technology Assessment Programme
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
• Diagnostic technologiesRadio immunoassay
Flexible endoscopy
Computerised tomography
Diagnostic ultrasound
• Therapeutic technologies1,106 new drugs marketed 1970-92
New devices (pacemakers, stents…..)
New surgical procedures (transplantation, laparoscopy…)
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
Pre
sc
rip
tio
ns
(m
illi
on
s)
Drugs
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
Pre
scri
pti
on
s (t
ho
usa
nd
s)
4S
CARE
WOSCOPS
(statins £308m)
Coronary revascularisation procedures, UK
0
5,000
10,000
15,000
20,000
25,000
30,000
1980 1985 1990 1995 2000 2005
Year
Pro
ce
du
res
Percutaneous coronary intervention Coronary
artery bypass grafting
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
• 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
•Clarity (and accountability) of function
•Application of the right skills and competencies
•Assessments are transferable and replicable
Why Separate Assessment and Appraisal?
HTA Programme
NICE
National Screening Committee
NSCAG
National:
[Local commissioning]
[Clinician/patient]
Assessment
Appraisal
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?
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
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
PubMed
0
10
20
30
40
50
60
1980 1985 1990 1995 2000 2005
Year
Pu
blic
ati
on
s/1
00
,00
0/y
r
Adjusted Bayes*
Adjusted health economic*