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Technology Assessment and Guidance for Purchasers

The National Research & Development Programme now has a comprehensive system of technology assessment in place. The following are the main components of this system.

Purchasers are, however, faced with an immense amount of change in the service provided for their population. Change is taking place at an ever faster rate with new drugs, new treatments and new interventions being introduced too quickly for the system of technology assessment to be expected to be able to cope with.

Purchasers will be consulted on major expenditure planned by trusts, for example the purchase of a new MR unit or the development of a new service. Purchasers can also be proactive in the topics covered by the Cochrane Collaboration, the York Effectiveness Bulletins, and the subjects covered by the R&D Technology Assessment Programme. As part of the Oxford Region's responsibility for linking research and purchasing we plan in Bandolier to produce much briefer reports to help purchasers cope with what is being called "technology creep".

Technology Creep

As knowledge grows seemingly exponentially, professionals innovate by implementing that knowledge, often using their own criteria for judging the quality of research and the cost-effectiveness of the service changes which seem to be indicated by the research findings. Many of these changes may, by themselves, be quite small - for example, £20,000 capital and £30 per finished consultant episode in revenue costs. However, the Trust that adopts 25 of these in the course of a year will be committing itself to £500,000 of capital expenditure without necessarily exposing it to the purchasers, and may be increasing the cost of care by significant amounts, again without discussing with purchasers the implications of the actions taken.

In each clinical department the change appears to be too small to discuss with purchasers, and to the diagnostic services the increase in costs may simply be one to be passed on to the clinical departments, who in turn pass on costs to purchasers.

There are different forms of technology creep:-

Moving mountains

The Chinese proverb says that the person who wishes to move mountains must begin by moving small rocks. We will be describing interventions and changes in practice that will have relatively small effects on cost, but it is important to bear in mind that 100 changes, each costing £5000 equal half a million pounds of purchasing power, and in many services changes costing £5000 are relatively commonplace.

Finding Bullets

The Cochrane Collaboration and the Centre at York will be producing reviews based on the evidence in randomised controlled trials. We will be seeking information for purchasers from two sources:-

We would also very much welcome input from purchasers. If any purchaser has either specified a particular test or treatment, or has specified that they do not wish a particular test or treatment to be used in their population, we would be pleased to hear from them and include examples in Bandolier .

Our Objectives

Our objectives are to help you as purchasers increase the detail in your specification, indicating what you think providers should provide or not provide.

There is an interesting third class of intervention where purchasing and R&D overlap, and that consists of those interventions that should only be provided as part of a randomised controlled trial.

J A Muir Gray MD FRCP (Glas) MRCGP FFCM
Director of Health Policy and Public Health

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