Health Technology Assessments: Getting the Right Balance in Medicine
Scientists spend many years collecting evidence about new health technologies to show they work and are suitable to use in people. However, showing that a health technology works is only part of the story!
Every year, scientists and doctors discover new health technologies: new ways of treating or preventing health problems. A health technology might be a new medicine; a machine to help diagnose or treat an illness; or a new way of doing medical assessments or a new type of surgery.
Scientists spend many years collecting evidence about new health technologies through clinical and laboratory research to show they work and are suitable to use in people. However, showing that a health technology works is only part of the story!
Consider bowel cancer screening as an example…
Bowel cancer is the second biggest cancer killer in Europe (after lung cancer) affecting more than 228,000 people per year.1 If it is detected at its earliest stage, more than 9 out of 10 people can be cured.2 If it is detected at a late stage (after it has spread to other parts of the body), only 1 out of 10 people will survive for 5 years.2
Early bowel cancer has few obvious symptoms, so the best way to detect it is by running screening programs in healthy people. Screening is usually done by looking for blood in a stool sample, or by a medical procedure called a sigmoidoscopy, where a thin flexible tube with a camera is used to look inside the bowel.3
In most countries, screening is only offered to certain people who are known to have a higher than normal risk of developing the disease (e.g. older people or those with a family history of bowel cancer).3-6 If early detection of bowel cancer is so important, why don’t we screen everyone to find the few who are affected?
Screening programs need to balance the benefits of detecting bowel cancer early, against the risks and costs of the screening procedure, which may include:4-6
- Inconvenience and discomfort for people coming into the clinic for screening
- Doctors’ and nurses’ time to arrange the screening and analyze the results
- Cost of buying and maintaining screening equipment
- A chance of getting misleading screening results, causing patients to worry unnecessarily
- A chance of missing cancer at an early stage, despite screening
- A small chance of harm from screening, such as bleeding or tearing of the bowel
By considering all of these factors in a logical, structured way, it is possible for independent researchers to advise doctors and governments about the best way to design screening programs for bowel cancer. This is an example of a health technology assessment.
What is involved in a health technology assessment?
A health technology assessment is a type of research that looks at medical, social, financial, and ethical information to find the best way to solve a specific health problem.7 The assessment involves asking questions about how to use the health technology at the right time, in the right way, for the right group of patients. It also looks at whether the benefit gained from the new technology is worth the possibility of side effects and the costs associated with using it.7-9
Researchers conducting a health technology assessment use evidence from a wide range of sources. These usually include the results of clinical research and laboratory studies, as well as financial assessments done by specialists called health economists.9
Patients and patient groups play an essential part in health technology assessments.10 From the start of the research process, patients can help to define what a meaningful improvement in their disease would feel like to them, and how it could be measured.11 Patients may also be asked to talk to health technology assessors about their own experiences of healthcare, which can help to identify factors that should be considered during the assessment.12 For example, if patients say that they find it difficult to attend hospital for regular injections, the assessors may place greater value in an equally effective new medicine that can be given at home.
All of this information is used to calculate how many people are likely to benefit from the new health technology, and how big the impact on their length or quality of their life may be.9
Can health technology assessments improve the practice of medicine?
Health technology assessments influence the decisions of governments, doctors, insurance companies, and the general public. Their main purpose is to inform people who set health policies and decide how a country’s or a company’s health budget is spent.13 Overall, they aim to achieve the best outcomes for the highest number of people within the health budgets available.13
Health technology assessments often form the basis for published national or international guidelines that doctors can consider when treating their patients. Guidelines are intended to make it easier for doctors to make treatment decisions based on the latest evidence. Some guidelines include recommendations on the best order or sequence to use different available medicines or treatments for a particular disease.9 They also help to ensure that people in different parts of a country or region receive a similar standard of healthcare.9
To ensure healthcare continues to be accessible and affordable for as many people as possible, decisions about how to use new medical technologies are vital.
People who plan health budgets and research spending may use health technology assessments to identify what they think will be the most important future developments in medicine. This allows them to calculate how much money should be set aside for future costs of healthcare.14 These types of analyses may also be used by researchers to find gaps in evidence or new technologies that can be developed to address unsolved health problems.13,14
In many countries around the world, money and time allocated for spending on healthcare is limited.15 To ensure healthcare continues to be accessible and affordable for as many people as possible, decisions about how to use new medical technologies – that are often expensive – are vital. By systematically considering the evidence, health technology assessments can help us to understand how the best value can be gained from available medicines and procedures to improve the lives of patients.15
- GLOBOCAN 2012 Estimated Cancer Incidence and Mortality Worldwide in 2012. International Agency for Research on Cancer 2012. Available from: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx
- Bowel Cancer Survival Statistics. Cancer Research UK 2012. Available from: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/survival#heading-Three
- Screening for Bowel Cancer. National Health Service, Sept 2014. Available from: http://www.nhs.uk/conditions/Cancer-of-the-colon-rectum-or-bowel/Pages/Screeningforbowelcancer.aspx
- Health technology assessment (HTA) of a population-based colorectal cancer screening programme in Ireland. Health Information and Quality Authority Mar 2009. Available from: http://www.ncri.ie/sites/ncri/files/pubs/HTA_population_based_colorectal_cancer_screening_programme.pdf
- Gutiérrez-Ibarluzea I, Asua J, Latorre K. Policies of screening for colorectal cancer in European countries. Int J Technol Assess Health Care. 2008;24(3):270-6.
- What is Bowel Cancer Screening? Macmillan Cancer Support UK. Available from: http://www.macmillan.org.uk/information-and-support/diagnosing/how-cancers-are-diagnosed/bowel-screening/what-is-bowel-cancer-screening.html#tcm:9-3769
- Medical Devices: Health Technology Assessment. World Health Organisation. Available from: http://www.who.int/medical_devices/assessment/en/
- Policy on Health Technology Assessment. European Commission. Available from: http://ec.europa.eu/health/technology_assessment/policy/index_en.htm
- Technology Appraisal Guidance. National Institute of Health and Care Excellence. Available from: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-technology-appraisal-guidance
- Facey K, Boivin A, Gracia J, et al. Patients’ perspectives in health technology assessment: a route to robust evidence and fair deliberation. International Journal of Technology Assessment in Health Care 2010; 26(03): 334-340.
- Patient involvement in the HTA decision-making process. European Patients’ Academy. Available from: https://www.eupati.eu/patient-involvement-in-the-hta-decision-making-process/
- Glossary. National Institute of Health and Care Excellence. Available from: https://www.nice.org.uk/article/pmg19/chapter/glossary#patient-expert
- Scott NA, Moga C, Harstall C, et al. Using health technology assessment to identify research gaps: an unexploited resource for increasing the value of clinical research. Healthc Policy. 2008; 3(3): e109–e127.
- Sullivan SD, Watkins J, Sweet B, et al. Health technology assessment in health-care decisions in the United States. Value Health. 2009; 12(2): S39-44.
- Health technology assessment (HTA). International Alliance of Patient Organizations. Available from: https://www.iapo.org.uk/health-technology-assessment-hta