Intended for healthcare professionals

How Do New Technologies Get Into Practice

Keeping pace with new technologies: systems needed to identify and evaluate them

BMJ 1999; 319 doi: (Published 13 November 1999) Cite this as: BMJ 1999;319:1291
  1. Andrew Stevens, professor of public health (,
  2. Ruairidh Milne, scientific directorb,
  3. Richard Lilford, professor of health services researcha,
  4. John Gabbay, professor of public healthc
  1. a Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT
  2. b National Coordinating Centre for Health Technology Assessment, University of Southampton, Southampton SO16 7PX
  3. c Primary Medical Care, University of Southampton, Southampton SO16 5ST
  1. Correspondence to: A Stevens

    Of the three major pressures on health services worldwide—changing demography, growing expectations, and new healthcare interventions (technologies) —the last is generating the most concern and the most dramatic responses. New healthcare technologies are becoming more numerous, more expensive, and possibly more effective than ever before. About 50 new drugs are launched each year, and the number of new devices, procedures, and ways of providing care is growing all the time.

    Summary points

    New and changing technologies are a major pressure on health services, challenging cost control and research capacity

    The NHS system to identify and evaluate new technologies and select the most important ones for assessment needs to develop a range of suitable research methods and the means to disseminate knowledge and implement the technologies

    A pragmatic research solution is evolving, with rapid reviews, modelling, economic evaluation, and pragmatic trials as well as the mainstream efficacy trials and Cochrane reviews

    Closer contact between research managers and the research team and new tools such as tracker trials may need to be developed too

    Effectiveness: clinical and cost

    Not only is there a challenge in relation to cost control, but, more compellingly, in relation to determining effectiveness.1 For example, it is often not clear:

    • Which patients will benefit most

    • What the balance of benefits and harms is

    • What value for money technologies offer

    • How affordable they are

    • Whether it is appropriate for them to be provided by the NHS.

    Without this information there is a risk of distorted priorities as political pressure to keep a lid on budgets creates a tension between the claims of different technologies for part of the public purse.

    In 1992 the Advisory Group on Health Technology Assessment suggested that the “costs of providing unevaluated new forms of care within the NHS should be met only if they are being offered within the …

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