Intended for healthcare professionals


Introducing new health interventions

BMJ 2006; 332 doi: (Published 12 January 2006) Cite this as: BMJ 2006;332:64

Re: 'Diagnostics may well be a Cinderella, but not of health technology assessment

Dr Furness makes a very important point about the lack of emphasis on
diagnostics, but ironically he (or at least his headline) has got the
wrong diagnosis. As we tried to make clear in our editorial (Gabbay J and
Walley T:
Introducing new health interventions
BMJ 2006; 332: 64-65) there is a long chain from health technology
assessment (HTA: the scientific summation of evidence about effectiveness)
through appraisal (i.e. the policy related judgements that the National
Institute for Health and Clinical Excellence and others then make on the
basis of the assessments) through to the implementation and availability
of services. The neglect of diagnostics lies not with HTA, as the title
of his letter suggests, but further along the chain.

The NHS HTA Programme has in fact given a great deal of attention to
diagnostics. Although HTA covers all health care interventions from
health promotion through disease prevention, diagnosis, treatment and
rehabilitation through to continuing care, the HTA Programme has devoted
one of its four expert panels (indeed until this year one of only three)
entirely to diagnostics and screening. The Programme has published no
fewer than 36 monographs about diagnostic technologies
( and has
commissioned a further 32 research projects that are now under way.

As we
highlighted in our editorial, the assessment of diagnostics poses some
particularly difficult methodological challenges. Clearly, however, there
is an even greater challenge to ensure that once a diagnostic technology
has been assessed as cost-effective it is made properly and widely
available in the NHS. If we are to tackle that problem, then let us at
least understand where and how it is happening, rather than jumping to
blame the wrong part of the system.

Competing interests:
JG was Director of the NHS National Coordinating Centre for Health Technology Assessment 1998-2004. TW is Director of the NHS HTA Programme

Competing interests: No competing interests

30 January 2006
John Gabbay
Professor Emeritus
Tom Walley
Wessex Institute for Health R&D, University of Southampton SO16 7PX