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Assessment and Appraisal: Fundamental Aspects of Health Care

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

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Assessment and Appraisal: Fundamental Aspects of Health Care

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  1. Assessment and Appraisal:Fundamental Aspects of Health Care Kent Woods Director, NHS Health Technology Assessment Programme

  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. Drugs

  5. (statins £308m) CARE WOSCOPS 4S

  6. Percutaneous coronary intervention Coronary artery bypass grafting

  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. Responding to the challenge of new technologies • Assessmentis a research activity and produces generalisable new knowledge • ‘Appraisal’ applies that knowledge to specific local circumstances: • Applicability • Social values • Local priorities • Local resources

  9. Why Separate Assessment and Appraisal? • Clarity (and accountability) of function • Application of the right skills and competencies • Assessments are transferable and replicable

  10. Assessment Appraisal National: NICE National Screening Committee HTA Programme NSCAG [Local commissioning] [Clinician/patient]

  11. 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?

  12. 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

  13. Science informs, but does not dictate, decisions in health care • The scientific challenges are: • Synthesising evidence validly • Quantifying uncertainty • Communicating probabilities to those making decisions

  14. 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

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