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Health technology assessment in obstetrics and gynaecology. Part 2: application in practice
Author(s) -
Abedin Parveen,
Daniels Jane,
Khan Khalid S
Publication year - 2007
Publication title -
the obstetrician and gynaecologist
Language(s) - English
Resource type - Journals
eISSN - 1744-4667
pISSN - 1467-2561
DOI - 10.1576/toag.9.3.181.27339
Subject(s) - health technology , medicine , economic evaluation , obstetrics and gynaecology , systematic review , cost effectiveness , gynecology , medline , health care , pregnancy , risk analysis (engineering) , pathology , biology , political science , law , economics , genetics , economic growth
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.