Sometimes, I hear colleagues suggest that the NIHR Health Technology Assessment (HTA) Programme is methodologically conservative, and that it only addresses “dull but needed” research. Evidence based on current HTA activity suggests a very different picture. Today, the HTA is one of the most dynamic, innovative, comprehensive, efficient and productive funders of pragmatic clinical trials and systematic reviews worldwide. In this talk, I shall tell you more about the HTA, what it does, what it does not do, how it does it and how it benefits patients and the public.
The HTA was set up in 1993 to fund independent patient-centred “real world” research into mature health technologies that could be used in the UK National Health Service and beyond. By “technology”, I mean any method used to promote health, prevent disease, treat disease or improve rehabilitation and long-term care. A unique aspect of the HTA Programme has been its role in challenging the research community by commissioning research using sophisticated topic identification and prioritisation processes informed by existing systematic reviews of evidence and evidence users’ needs. In 2006, the HTA introduced a researcher-led funding stream to complement the commissioned work stream resulting in a creative and complex adaptive system that helps to balance the current HTA portfolio of over 400 active studies across disease categories. Topics may include “market failure” research on inexpensive but potentially effective treatments, or gathering better evidence on treatments in current use that could be stopped. Treatments are not confined to drugs and may include complex interventions such as talking therapies, physical rehabilitation or diagnostic care pathways. Typically, HTA studies assess effectiveness and cost effectiveness so that those funding care can make evidence-based purchasing decisions. Patients and the public are at the heart of all HTA processes to ensure research remains relevant, realistic and deliverable.
The HTA funds innovative designs including cohort RCTs, efficient use of routine data within RCTs and a range of adaptive study designs. The programme is a key stakeholder and contributor to trial methodology initiatives such as the MRC Hubs for Trials Methodology Research and Methodology Research Programme, and conducts its own suite of “research on research”. The HTA is also intent on reducing avoidable research by ensuring that all its projects are grounded in existing evidence from systematic reviews where possible, that core outcome sets are used if available, and all funded studies are registered prospectively and published in full. Deft management of the programme making it as easy and rapid as possible to fund needed research are also priorities for the Programme, provided scientific quality is not compromised.
The debate on whether the HTA is conservative or cutting edge is a distraction. What is important is ensuring that it uses public monies to fund outstanding teams to design and deliver efficient studies using appropriate designs for the benefit of patients in the UK and worldwide.
Raftery J, Powell J. Health Technology Assessment in the UK. Lancet 2013;382:1278-85.