a1 National Institute for Health and Clinical Excellence
a2 National Institute for Health and Clinical Excellence and University of Cambridge
a3 National Institute for Health and Clinical Excellence
a4 National Institute for Health and Clinical Excellence and Universities of Exeter and Plymouth
Objectives: The aim of this study was to identify and compare health technology assessments of the same new interventional procedures produced in different countries.
Methods: We selected five new interventional procedures and studied related assessments produced in different countries.
Results: There were twenty assessments (range, 3–5 per procedure) from nine countries—fourteen from Australia, Canada, and United Kingdom. The number of primary RCTs cited by the assessments ranged from 0 to 13. In the assessment reports, “headline” statements about the strength of evidence for efficacy (73 percent) were made more frequently than for safety (53 percent). These statements were scored for their apparent judgment of the strength of the evidence—1 (poor) to 5 (strong)—and received scores of 3 or less in all but four cases. Recommendations about additional research were included in 55 percent of the assessments. Statements in assessments about other aspects of use of the procedures were included more infrequently—in 35 percent for patient selection, in 20 percent for consent issues, and in 15 percent for types of clinical teams. Recommendations about appropriate healthcare settings, or about operator training, were included only in assessments produced by a single organization.
Conclusion: There was a only small number of assessments world-wide, for a range of new procedures with potentially high impact. Where available, assessments were produced on a relatively poor evidence base. International collaboration in evidence appraisal and review, and in the gathering of new data through research or registers, could improve the advice available to healthcare systems worldwide about the adoption of new interventional procedures.
We acknowledge the help of Mirella Marlow, NICE Director—Devices and Diagnostic Systems, for her assistance with the administrative arrangements for the study. The authors have not received any funding from external sources for the conduct of this study. Jonathan Plumb undertook the main aspects of the work relating to this study when seconded from the post of Nursing Advisor, Devices Clinical Division, Medicines and Healthcare products Regulatory Agency, as part of the UK's National School for Government Senior Development Programme for Professionals.