gms | German Medical Science

6. Symposium Health Technology Assessment

Deutsche Agentur für HTA des DIMDI – DAHTA@DIMDI

03. bis 04.11.2005, Köln

The challenges for HTA: implications for the new genetics

Meeting Abstract

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  • author John Gabbay - Wessex Institute of Health Research and Development, University of Southampton, Southhampton, Great Britain

Deutsche Agentur für Health Technology Assessment des Deutschen Instituts für Medizinische Dokumentation und Information. 6. Symposium Health Technology Assessment. Köln, 03.-04.11.2005. Düsseldorf, Köln: German Medical Science; 2006. Doc05hta08

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/hta2005/05hta08.shtml

Veröffentlicht: 13. Februar 2006

© 2006 Gabbay.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Abstract

Health Technology Assessment is part of a chain of activity that spans from science through policy judgement to clinical activity. In the UK we have made a distinction between supposedly objective scientific assessment and the value based policy judgement called appraisal. Since it began in 1993, the NHS HTA Programme has been concerned solely with the former, and has now produced over 300 HTA reports with many more on the way. To achieve this it has forged a links with both researchers and NHS decision-makers to develop a programme that asks the most pressing HTA questions and answers them by commissioning and publishing high quality research. The potential audience for all this output is very varied, including not only clinicians and policy makers, but also patients, manufacturers, managers, funders, the media, politicians and many more key players in the healthcare system. One key recipient of HTA reports has recently become the formal organisations - especially NICE - that in the UK have responsibility for appraisal and for issuing guidance about the use of health technology. Since 1999, the HTA programme has had a close relationship with NICE, mainly in providing rapid, robust and reliable assessments upon which NICE can base its appraisals in the light of evidence from many other interested parties.

But I will argue that this model exposes the fact that these other interests have a major role at all stages of the chain from science to clinical activity, and that HTA cannot continue to succeed by considering itself as being an objective scientific enterprise focussing solely on epidemiological and economic analyses. Firstly, HTA findings are pitched into a highly political environment, which can easily overwhelm them; secondly appraisal requires help with much more than the basic facts about cost-effectiveness; and thirdly, we must accept that HTA, as the bridge between science and policy making is itself subject to many pressures from a wide range of interested parties. HTA always needs to compromise between the scientific rigour and policy relevance, which leads to a number of specific challenges that HTA needs to overcome if it is to succeed in the long run. These challenges fall into three main areas:

1.
identifying the technologies that are most in need of assessment, where there are tensions between - for example - duplicating international assessments and achieving local relevance; between assessing technologies early in their trajectory and wasting effort by choosing some that do not flourish, and between preventing and encouraging innovation in healthcare;
2.
conducting robust assessments in difficult topic areas that require methodological innovation - especially in difficult areas such as diagnostics and screening, rapidly evolving technologies - and also must include methods to assess the ethical and other wider aspects of HTAs;
3.
fostering the implementation of the HTA findings, which in addition to the usual huge problems of encouraging the uptake of research into practice, is for HTA deeply reliant on the nature of the healthcare system and highly vulnerable to interest groups.

Nowhere are these inherent tensions of HTA more likely be true than in dealing with the new genetics. This is not because genetics are in any way a different category of technology from those already subject to HTA - indeed I shall argue that they are not. But they will pose special challenges in defining and identifying the technologies to be assessed from among the myriad that will emerge from this field; in developing the methods for assessing their complex and pervasive impact on the population and its health; and in giving HTA a sufficient voice in cacophony of interests that will shape the influence of the new genetics on health.


Notes

The complete lecture can be found on the website of DIMDI: http://www.dimdi.de/static/de/hta/symposien/2005/index.htm