Developing a Systematic Approach to Health Technology Assessment

Background

Health Technology Assessment (HTA) is a systematic approach to evaluating the safety, clinical and cost effectiveness of drugs and medical interventions.  As the Director of the Liverpool Health Economics Group (LHEG) Alan Haycox has been instrumental in influencing national and international health policies, including:

  • Prior to 1999, the introduction of new drugs into the NHS was the responsibility of hospital-based committees who would decide independently whether to introduce new drugs. Different committees frequently made contradictory decisions leading to allegations that a fundamental NHS principle (equal access for patients in equal need) was being replaced by a postcode lottery. Alan’s research argued for the establishment of a single evaluative body that would centralise expertise and undertake HTA on behalf of the entire NHS - and the National Institute for Clinical Excellence (NICE) which was established in 1999.
  • Under Alan’s Directorship, the Liverpool Review and Implementation Group was forged; one of seven independent academic units funded by the NHS to undertake economics cost-benefit research with a specific aim to inform the policy decisions of NICE.
  • The LHEG has undertaken research in a wide range of therapeutic areas including thrombolysis insomnia, coronary artery stents and pemetrexed for the treatment of malignant pleural mesothelioma, providing an evidence base to ensure the optimum treatment pathways for different sub groups of patients in each therapeutic area.
  • HTA research at Liverpool attained international recognition allowing the LHEG to assist in the development of research and policy strategies in parts of the world in which healthcare systems were changing rapidly. The first collaboration (the Piperska Alliance) was established in 2008 between the LHEG and the Karolinska Institute (Stockholm) and the Mario Negri Institute (Milan). This multidisciplinary network was established to undertake research aimed at informing national healthcare policies in the countries of Central and Eastern Europe. Such countries had limited experience of either health research or health policy formulation in a market based environment and so a supportive research network was established to develop skills and directly undertake research in such countries.
  • Other international collaborations have been established which emphasise the impact and international reach of the LHEG’s research. In particular, LHEG has played a key role in developing infrastructures and ‘roadmaps’ for the establishment of HTA systems in South East Asia and North Africa.

Applying the Research

Research into HTA undertaken by the LHEG has led to significant impacts at the local, national and global levels.

  • Local Level Impact.  LHEG provide advice to the Liverpool Clinical Trials Unit (CTU), the largest CTU in the North West. Through this work LHEG research has optimised resources allocated to a wide range of therapeutic areas, including evaluating the Liverpool care pathway for end of life care to a range of projects with Liverpool Women's Hospital in the fields of paediatric and neonatal medicine.
  • National Level Impact. The LHEG has played an important role is establishing the policy and practice of drug adoption in the NHS, including changing the national policy for the treatment of coronary artery disease. This was done by identifying the optimal relationship between resource allocation and clinical pathways and outcomes, for patients suffering a heart attack. The research emphasised the importance of providing patients with access to Thrombolysis during the one hour period (known as the 'golden hour') following the attack.
  • International Level Impact.  Liverpool has contributed substantially to International Healthcare Policy; specifically research in Central Eastern Europe, South East Asia, and North Africa facilitating the implementation of structures and skills for HTA that optimise the introduction of new drugs into national healthcare systems. Many of the health systems of low to middle income countries are in flux with regard to the nature and structure of their healthcare systems. In support of universal coverage, LHEG research has helped to champion the use of structures for HTA as a 'rationing' device to maintain healthcare expenditure within sustainable levels where HTA is used as a means to allocate scarce healthcare resources.

Making a Difference

  • Alan was invited to join the NICE Appraisal Committee in 2008, and his role in NICE has been crucial in extending the impact of the research undertaken at Liverpool globally.
  • The Piperska Alliance now coordinates and collaborates with over twenty Central Eastern European countries in undertaking research to inform national policies and to optimise resource use in their healthcare systems.