Hostname: page-component-7c8c6479df-nwzlb Total loading time: 0 Render date: 2024-03-28T14:30:21.603Z Has data issue: false hasContentIssue false

Differences between systematic reviews and health technology assessments: A trade-off between the ideals of scientific rigor and the realities of policy making

Published online by Cambridge University Press:  28 May 2004

Dalia Rotstein
Affiliation:
Institute for Evaluative Sciences
Andreas Laupacis
Affiliation:
Institute for Clinical Evaluative Sciences University of Toronto

Abstract

Objectives: To elucidate important differences between a health technology assessment (HTA) and a systematic review, using an HTA of positron emission tomography (PET) as an example.

Methods: Interviews with seventeen individuals who were authors or users of the PET HTA.

Results: Those interviewed identified seven areas in which HTAs often differ from traditional systematic reviews: (i) methodological standards (HTAs may include literature of relatively poor methodological quality if a topic is of importance to decision-makers), (ii) replication of previous studies (relatively common for HTAs but not systematic reviews), (iii) choice of topics (more policy oriented for HTAs, while systematic reviews tend to be driven by researcher interest), (iv) inclusion of content experts and policy-makers as authors (policy-makers more likely to be included in HTAs, although there are potential conflicts of interest), (v) inclusion of economic evaluations (more often with HTAs, although economic evaluations based upon poor clinical data may not be useful), (vi) making policy recommendations (more likely with HTAs, although this must be done with caution), and (vii) dissemination of the report (more often actively done for HTAs).

Conclusions: This case study of an HTA of PET scanning confirms that HTAs are a bridge between science and policy and require a balance between the ideals of scientific rigor and the realities of policy making.

Type
GENERAL ESSAYS
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Battista RN, Hodge MJ. 1999 The evolving paradigm of health technology assessment: Reflections for the millennium. Can Med Assoc J. 160: 14641467.Google Scholar
Council of Medical Imaging, Ontario Medical Association. 1999 Positron emission tomography. Oakville, Ontario: Ontario Medical Association;
Dussault F-P, Nguyen VH, Rachet F. 2003 Positron emission tomography in Quebec. Available at: www.aetmis.gouv.qc.ca/fr/publications/scientifiques/imagerie_medicale/2001_03_en.pdf. Accessed: April 8,Google Scholar
Garber AM, Solomon NA. 1999 Cost-effectiveness of alternative test strategies for the diagnosis of coronary artery disease. Ann Intern Med. 130: 719728.Google Scholar
Institute for Clinical Evaluative Sciences. 2003 Health technology assessment of positron emission tomography, 2001. Available at: www.ices.on.ca. Accessed: April 3,
2003 International Network of Agencies for Health Technology Assessment. Available at: www.inahta.org. Accessed: April 3,
Laupacis A, Levin L, Evans W, et al., 2003 for the PET Evaluation Steering Committee of Ontario. A strategy to evaluate the diagnostic role of positron emission tomography scanning in cancer. Presented at ISTAHC 2003. Canmore, Canada: June,
Lomas J. 1993 Diffusion, dissemination, and implementation: Who should do what? Ann N Y Acad Sci. 703: 226235.Google Scholar
Oxman AD, Guyatt GH. 1988 Guidelines for reading literature reviews. Can Med Assoc J. 138: 697703.Google Scholar
Siebelink HJ, Blanksma PK, Crijns HJ, et al. 2001 No difference in cardiac event-free survival between positron emission tomography-guided and single-photon emission computed tomograph-guided patient management. J Am Coll Cardiol. 37: 8188.Google Scholar