The Obstetrician & Gynaecologist 2007;9:3:181-187
doi: 10.1576/toag.9.3.181.27339
Copyright © 2007 by the Royal College of Obstetricians and Gynaecologists.
Health technology assessment in obstetrics and gynaecology. Part 2: application in practice
Parveen Abedin, MSc MRCOG, Locum Consultant Obstetrician and Gynaecologist1,
Jane Daniels, BSc MMedSci MSc, Senior Research Fellow and Unit Co-ordinator2 and
Khalid S Khan, MMed MRCOG, Professor of Obstetrics, Gynaecology and Clinical Epidemiology3
1. Good Hope Hospital, Rectory Road, Sutton Coldfield, Birmingham B75 7RR, UK Email: Pabedin{at}doctors.org.uk (corresponding author)
2. Birmingham Women's Hospital, UK
3. Birmingham Women's Hospital, UK
Key content:
- The process of health technology assessment (HTA) is demonstrated using two examples: a systematic review and a clinical trial.
- The HTA of anti-D prophylaxis for Rh-negative pregnant women was undertaken to inform a decision on whether to introduce this intervention universally.
- Using statistical methods to pool the results, it was calculated that the number needed to treat with antenatal anti-D prophylaxis to avoid one case of sensitisation was 278.
- The EVALUATE trial was designed to investigate differences in complication rates between laparoscopic and abdominal hysterectomy and between laparoscopic and vaginal hysterectomy.
- The laparoscopic procedure has a higher mean cost per quality-adjusted life year (QALY), but it scores significantly higher on all the quality of life questionnaires. Ultimately, it will be the willingness of the National Health Service to pay the extra cost per additional QALY that will decide whether it is adopted into routine practice.
Learning objectives:
- To understand, through examples, the practical application of the process of HTA in everyday clinical practice.
- To appreciate the incorporation of clinical and economic evaluations into assessment of effectiveness.
- To understand the quality criteria for assessing primary studies in a systematic review.
Ethical issues:
- It is no longer sufficient to consider only the clinical effectiveness of a technology. HTA should include an economic evaluation to determine value for money.
- Systematic reviews provide evidence of effectiveness, although implementation of a technology will depend on its relative importance to policy decision makers.
- Researchers need to be transparent in any shortcomings in the design or conduct of their trials and reviews.
Please cite this article as: Abedin P, Daniels J, Khan KS. Health technology assessment in obstetrics and gynaecology. Part 2: application in practice. The Obstetrician & Gynaecologist 2007;9:181–187.
Keywords anti-D prophylaxis / health technology assessment / hysterectomy / randomised controlled trial / systematic review
Copyright © 2007 by the Royal College of Obstetricians and Gynaecologists.
