Introducing new health interventions: Diagnostics is the Cinderella of health technology assessment

doi:10.1136/bmj.332.7535.235-b

BMJ 2006;332:235-236 (28 January), doi:10.1136/bmj.332.7535.235-b

Letter

Introducing new health interventions

Diagnostics is the Cinderella of health technology assessment

The first 150 words of the full text of this article appear below.

Editor—The several papers on evaluating new healthcareinterventions omit any mention of a crucial sector of healthcare: diagnostics.^1-3 The National Institute for Health andClinical Excellence (NICE) shares this blindspot.

The importance of diagnostics has recently been highlightedby the sudden introduction of Herceptin (trastuzumab) treatmentfor all women with breast cancer who could benefit. Qualitycontrolled laboratory assessment of HER2 status, essential todefine those who could benefit, was not adequately consideredand serious problems resulted.

The problem is being exacerbated by the advances of molecularbiology. For example, a paper in last month's Journal of Pathologyargues cogently that all new colorectal cancers should be testedfor DNA mismatch repair deficiency.⁴ So should NHS pathologylaboratories all be doing this? Perhaps not yet—the verynext paper in the same issue illustrates quality control problemswith this investigation.⁵

A systematic and authoritative approach to evaluating new diagnostictests . . . [Full text of this article]

Peter N Furness, consultant histopathologist

Leicester General Hospital, Leicester LE5 4PW pnf1@leicester.ac.uk