Health-technology assessment in surgery

Abstract

Health-technology assessment includes a wider range of activities than simply primary evaluations of defined techniques. First, it is necessary to prioritise technologies for assessment, since there are insufficient resources for the assessment of all unevaluated and novel technologies. Second, several primary evaluations of a technology may be required to provide a clear and comprehensive picture of its effects ¹ NHS Management Executive Assessing the effects of health technologies. Department of Health, London 1992 Google Scholar . Individual studies commonly include too few patients to produce a definitive answer, and the effects of a technology are often smaller than anticipated, yet clinically important. It is risky to generalise from a single study, particularly in surgery. Individual studies are not always able to assess the full range of clinical and patient-related outcomes, economic outcomes, short-term and long-term effects, and possible harm as well as benefit (panel 2). Weighing up the importance of different outcomes, such as quality and length of life, is a continuing challenge. ⁵ Billingham LJ Abrams K Jones DR Quality of life assessment and survival data.in: Black N Brazier J Fitzpatrick R Reeves BC Health services research methods: a guide to best practice. BMJ Books, London 1998: 163-172 Google Scholar Assessment of a new health technology also often involves other issues, such as humanity, equity, and ethics, and, in some cases, legal considerations. Panel 2 Effects of health technology to be assessed Tabled 1 Clinical outcomes: benefit, Short and long-term cure, absence/reduction in clinical signs, return of biochemical and physiological measures to normal values Clinical outcomes: harm Mortality, complications, and other adverse events attributable to the technology being assessed Patient outcomes: benefit Short-term and long-term absence/reduction in symptoms, increased ability to perform activities of daily living, increased quality and length of life Economic outcomes Use of hospital, primary care, social services resources and costs, and resource use and costs that fall on patients Impact on other services, Consequences of implementing new health technologies on other health services Open table in a new tab