Health Technology Assessment 1999; Vol. 3: No. 13 ‘Early warning systems’ for identifying new healthcare technologies G Robert A Stevens J Gabbay Health Technology Assessment NHS R&D HTA Programme HTA Standing Group on Health Technology Current members Chair: Professor John Gabbay, Professor Maggie Pearson, Professor Tom Walley, Professor Sir Miles Irving, Director, Wessex Institute for Regional Director of R&D, Department of Professor of Surgery, University Health Research & Development NHS Executive North West Pharmacological Therapeutics, of Manchester, Hope Hospital, Mr Hugh Ross, University of Liverpool Salford Professor Sir John Grimley Evans, Chief Executive, The United Dr Julie Woodin, Department of Bristol Healthcare NHS Trust Chief Executive, Professor Martin Buxton, Geriatric Medicine, Professor Trevor Sheldon, Nottingham Health Authority Professor of Economics, Radcliffe Infirmary, Oxford Director, NHS Centre for Brunel University Professor Kent Woods Dr Tony Hope, Reviews & Dissemination, University of York (Chair Designate), Professor Francis Creed, The Medical School, School of Psychiatry Professor Mike Smith, Regional Director of R&D, University of Oxford NHS Executive, Trent & Behavioural Sciences, Director, The Research University of Manchester Professor Richard Lilford, School of Medicine, Regional Director, R&D, University of Leeds Professor Charles Florey, West Midlands Department of Epidemiology Dr John Tripp, & Public Health, Ninewells Dr Jeremy Metters, Department of Child Health, Hospital & Medical School, Deputy Chief Medical Officer, Royal Devon & Exeter University of Dundee Department of Health Healthcare NHS Trust Past members Dr Sheila Adam, Professor Howard Mrs Gloria Oates, Professor Ian Russell, Department of Health Glennester, Chief Executive, Department of Health Sciences Professor Angela Coulter, Professor of Social Science Oldham NHS Trust & Clinical Evaluation, & Administration, London University of York Director, King’s Fund, London School of Economics & Dr George Poste, Professor Anthony Culyer, Political Science Chief Science & Technology Dr Charles Swan, Officer, SmithKline Beecham Consultant Gastroenterologist, Deputy Vice-Chancellor, Mr John H James, University of York North Staffordshire Chief Executive, Professor Michael Rawlins, Royal Infirmary Dr Peter Doyle, Kensington, Chelsea & Wolfson Unit of Executive Director, Zeneca Ltd, Westminster Health Authority Clinical Pharmacology, University of Newcastle- ACOST Committee on Medical Professor Michael Maisey, Research & Health upon-Tyne Professor of Radiological Professor John Farndon, Sciences, Guy’s, King’s & St Professor Martin Roland, Professor of Surgery, Thomas’s School of Medicine Professor of General Practice, University of Bristol & Dentistry, London University of Manchester Details of the membership of the HTA panels, the NCCHTA Advisory Group and the HTA Commissioning Board are given at the end of this report. 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The website also provides information about the HTA Programme and lists the membership of the various committees. ‘Early warning systems’ for identifying new healthcare technologies G Robert1 A Stevens2 J Gabbay3 1 Health Economics Research Group, Brunel University, Uxbridge, UK 2 Department of Public Health and Epidemiology, University of Birmingham, UK 3 Wessex Institute for Health Research and Development, University of Southampton, UK Competing interests None declared Published July 1999 This report should be referenced as follows: Robert G, Stevens A, Gabbay J.‘Early warning systems’ for identifying new healthcare technologies. Health Technol Assess 1999;3(13). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA web site (see overleaf). NHS R&D HTA Programme he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to T ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Methodology Panel and funded as project number 94/10/02. The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations. Reviews in Health Technology Assessment are termed ‘systematic’ when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. Series Editors: Andrew Stevens, Ruairidh Milne and Ken Stein Editorial Assistant: Melanie Corris The editors have tried to ensure the accuracy of this report but cannot accept responsibility for any errors or omissions. They would like to thank the referees for their constructive comments on the draft document. ISSN 1366-5278 © Crown copyright 1999 Enquiries relating to copyright should be addressed to the NCCHTA (see address given below). Published by Core Research, Alton, on behalf of the NCCHTA. Printed on acid-free paper in the UK by The Basingstoke Press, Basingstoke. Copies of this report can be obtained from: The National Coordinating Centre for Health Technology Assessment, Mailpoint 728, Boldrewood, University of Southampton, Southampton, SO16 7PX, UK. Fax: +44 (0) 1703 595 639 Email: [email protected] http://www.hta.nhsweb.nhs.uk Health Technology Assessment 1999; Vol. 3: No. 13 Contents List of abbreviations .................................... i 7 Synthesis of results ....................................... 57 Information sources ....................................... 57 Executive summary .................................... iii Establishment and operation of an EWS ...... 62 1 Aims ............................................................... 1 8 Conclusions and research 2 Background and rationale for the study ... 3 recommendations ........................................ 67 The need for an early warning