A researcher from the University of Liverpool’s Institute of Ageing and Chronic Disease, has published a paper about the challenges faced in introducing new devices and diagnostics into health services.
Dr Paul Knox, Reader, Eye and Vision Science, reflects on seven years’ experience as a member of the Medical Technology Advisory Committee (MTAC) at the National Institute for Health and Care Excellence (NICE). Writing with Professor Bruce Campbell (first chair of MTAC) in The International Journal of Technology Assessment in Health, he notes that making decisions about introducing new devices and diagnostics into health services are difficult because the amount of evidence about them is often limited.
NICE established its Medical Technology Evaluation Programme, of which MTAC is a part, to generate advice about the early adoption of promising technologies.
Improved process was needed
In the paper, entitled ‘Promise and Plausibility: Health Technology adoption decisions with limited evidence’, Campbell and Knox argue that when clinical and scientific evidence is sparse, judgements based on the promise of a new technology can still be made by balancing risks, costs and benefits against the available evidence, aided by clinical expert and patient input.
Plausibility (or “plausible promise”) is central to this kind of decision making and consensus can be reached by a broad-based committee like MTAC. These processes are different to conventional methods of HTA and are difficult to provide at a local healthcare level.
While the combined efforts of regulators and NICE may gradually promote an improved understanding and culture of evidence generation throughout the medical devices industry, this change is likely to be slow.
Transparency
Dr Paul Knox, said: “These assessments and decisions involve an element of judgement, experience, and occasionally professional intuition so a vital requirement is transparency.
“It should be possible to share with professional and public audiences how decisions have been reached and the information and considerations that have led to them.”
These processes can inform commissioners and funders of health care, as well as clinicians and patients, when they are making their own decisions about whether to adopt new technologies.
Higher risk
Dr Knox adds: “Any decision can be a wrong decision, and decisions made in the context of sparse evidence may carry a higher risk of being wrong. But not making decisions, or requiring impossible or impractical levels of evidence before making them, carries the risk of denying important innovations to patients.”
The full paper can be found here.
