MTV, sundhedstjenesteforskning og klinisk praksis

2.2 The British HTA programme: background and activities.
What does it mean for the clinician?
Miles Irving
The evidence-based approach to medical practice is increasingly
being accepted by clinicians across the spectrum of Health Care
provision. Indeed many would accept that it is an essential accompaniment
to the practice of medicine as we approach the 21st century.
Evidence based medicine is defined on the integration of individual
clinical expertise with the best available external clinical evidence
from systematic research. It is immediately apparent that the whole
framework depends upon access to “best available external clinical
evidence” and it is the purpose of the Health Technology Assessment
(HTA) programme to provide that evidence.
The background to the development of the British HTA programme
was a document entitled “Assessing the effects of Health Technologies”
which was commissioned by Professor Michael Peckham first
director of the National Health Service (NHS) Research and Development
programme. This report observed that many technologies
used in medicine have ultimately been shown to be harmful. Some
recognised as effective have only been adopted after unnecessary
and damaging delays whilst others have been shown to have no advantages
over existing and usually cheaper alternatives. However,
in most cases we simply do not know.
When it was decided to introduce a programme of HTA it was decided
to use a broad definition of health technology, namely “any
procedure used by Health Professionals to promote health, to prevent
and treat disease and to foster improved rehabilitation and
long term care.” This definition encompasses assessment of the
equipment used and the way it is used. Our philo-sophy is that we
should obtain hard evidence, preferably from ran-domised trials,
that the use of each technology either alters the natural history of
disease or otherwise benefits many patients at a reasonable cost. To
summarise it asks – does this technology work, for whom, at what
cost?
The need for such a programme becomes increasingly obvious
with the passage of time. New technologies for patient manage-
25