Health Technology Assessments are the gateway to validation for medical technologies in the UK. Naomi Stockley of NCCHTA explains the HTA programme and how the medtech industry can derive maximum benefit from it.

Computed tomography screening for coronary artery disease’, ‘laparoscopic surgery for colorectal cancer’ and ‘the management of critically ill patients with pulmonary artery catheterisation’ are some of the latest research reports published by the Health Technology Assessment (HTA) programme to expand the NHS evidence base. The HTA programme, set up in 1993, is part of the National Institute for Health Research (NIHR) and is the largest and longest-running of the Department of Health’s national research programmes. It has invested more than £136m in filling gaps in the NHS’s evidence about the clinical and cost-effectiveness of different healthcare treatments and tests: devices, surgery, settings of care, drugs, screening and talking therapies.
The research funded by the HTA programme informs NHS decision-makers and supports clinicians and patients in choosing the most appropriate care.

Working with partners

Relationships with the NIHR, the National Institute for health & Clinical Excellence (NICE) and other decision makers such as the National Screening Committee (NSC) provide strong direction for the work of the HTA programme. Much of the programme’s work is aimed at supporting research priorities. This currently includes a study investigating the clinical effectiveness of PET imaging for selected cancers, commissioned for the National Clinical Director for Cancer; and a clinical trial to inform the NSC, which is assessing the use of automated technology for cervical screening. The HTA programme provides NICE with technology assessment reports that are the main source of information the NICE appraisals committee use in their decision-making process. A recent HTA research report that helped to inform NICE guidance investigated the clinical and cost-effectiveness of laparoscopic surgery for colorectal cancer, and research has been commissioned to look into the effectiveness of cochlear implants for children and adults with severe to profound deafness.

Other HTA-funded research that will help to inform NHS purchasing decisions includes a trial into the clinical and cost-effectiveness of four different methods of mechanical support for severe ankle sprains: the Tubigrip, the Bledsoe boot, the below knee plaster cast and the Kendall Gel Brace. Research is also underway to compare two new continuous glucose monitoring devices, the GlucoWatch 2 and the Continuous Glucose Monitoring System, with conventional monitoring to see whether they improve diabetes control.

HTA-funded researchers are working directly with industry in a new clinical trial investigating whether water softeners help to reduce the severity of eczema in children. A team of water softener manufacturers led by the UK Water Treatment Association is providing technical and scientific advice, as well as meeting the costs of producing and supplying the water softeners.

New research pathways

The HTA programme has recently changed its approach to commissioning research.

Traditionally, it has commissioned work only where it has identified specific questions that the NHS needs answers to. Working through expert advisory panels, it has considered hundreds of suggestions for research that have come from the NHS, its users and other professional sources, deciding which are the most urgent and commissioning the best research team to carry out the work.

In addition to its existing commissioning route, the HTA programme has now launched a new HTA Clinical Trials stream of work. Set up following the establishment of the NIHR (a key element of the national strategy for NHS research), the new funding opportunity has resulted in a significant volume of research proposals being submitted for consideration. The programme provides research grants for clinical trials that address questions of direct relevance to clinical practice in the NHS and have outcomes that matter to patients. Researchers are invited to submit outline research proposals on an ongoing basis for consideration by the HTA Clinical Trials Commissioning Board.

Research being commissioned through this route includes an evaluation of PET for the detection of head and neck cancer, and different imaging techniques for lung cancer.

For more information, visit the funding opportunities page on the HTA website www.hta.ac.uk/calls.

A developing programme

The HTA programme has welcomed the recent publication of a review of health research funding by Sir David Cooksey, published in the Chancellor’s pre-Budget report at the beginning of December. The review notes the success of the HTA programme in providing the NHS with a high-quality evidence base, and suggests that the growing need of the NHS for such information could be met by expanding the programme further.

A key recommendation of the Cooksey Review is the establishment of an Office for Strategic Co-ordination of Health Research (OSCHR) to co-ordinate the efforts of both the NIHR and the Medical Research Council. The Review urges that as part of its new role, OSCHR should examine the case for further investment in Health Technology Assessment as part of a comprehensive spending review. Specifically, it says that the HTA programme could be expanded to strengthen its commissioning of primary research, clinical trials and research in themed health areas.

“The recommendations outlined in the Cooksey Review would allow us to build upon our important relationships with partners such as NICE and the National Screening Committee, as well as developing links further with NHS purchasing,” says Professor Tom Walley, Director of the HTA programme. “HTA research is a valuable resource for decision-makers, providing them with the information they need to consider, together with other factors such as values and resources, when deciding how to advise the NHS.”

HTAs and the medtech industry

All of the HTA programme’s research is generated by the needs of the NHS. Health Technology Assessments are only undertaken following the licensing or ‘kite marking’ of a device, and where there is uncertainty in the NHS about its clinical and cost-effectiveness. Suggestions for HTA research are assessed by our expert panels for their relevance to NHS practitioners, users and managers.

Health Technology Assessments are only undertaken following the licensing or ‘kite marking’ of a device, and where there is uncertainty in the NHS about its clinical and cost-effectiveness. Suggestions for HTA research are assessed by our expert panels for their relevance to NHS practitioners, users and managers.

The HTA programme works with industry through its relationships with the Centre for Evidence-based Purchasing (CEP), the Purchasing and Supplies Agency and the National Innovations Centre, with whom the HTA programme is working to improve assessment of rapidly evolving technologies. An HTA programme representative sits on the CEP prioritisation board, and the programme is currently commissioning research on the board’s behalf into new devices for monitoring heart performance during surgery.

The HTA programme looks at a wide range of technologies, and welcomes suggestions to help shape its research agenda. You can make a research suggestion via the HTA programme website www.hta.ac.uk/suggest.

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Communications Manager at the National Coordinating Centre for Health Technology Assessment (NCCHTA), Wessex Institute for Health Research & Development, University of Southampton.

For further information, contact Naomi Stockley, tel. 02380 595646, e-mail ns5@soton.ac.uk; or Ruth Allen, Communications Manager, NCCHTA, tel. 02380 595584, e-mail ruth.allen@soton.ac.uk.