COMMENT
evaluation would be undertaken either by MTEP or DAP.
Dr Crabb explained: “The real difference is that MTEP has been set up as a relatively quick process. They use the simpler process of assessing clinical effectiveness and cost-consequences analysis, which is suitable for the assessment of technologies that are unlikely to increase overall cost to the NHS and that will hopefully save money whilst at least maintaining patient outcome benefits compared to current NHS practice. MTEP also considers a broader range of technologies – medical devices and diagnostics.”
In contrast, the DAP only assesses diagnostics and uses the more complex cost-effectiveness analysis, to quantify what the patient outcome benefits of a technology will be, evaluating if the health benefits from a technology are value for money and a good use of NHS resources. NICE measures patient outcome benefits in a unit called the Quality Adjusted Life
Year (QALY); length of life improvements adjusted for quality of life. Cost effectiveness is expressed as the cost per QALY.
This type of evaluation is significantly more complicated, and is appropriate for the evaluation of new technologies that may increase overall costs to the NHS but that could potentially result in improvements to patient outcomes by providing improved diagnosis, leading to better treatment decisions.
Up to date
A key mechanism for identifying topics for both the DAP and MTEP is notification from a product sponsor, typically the manufacturer. Following consideration of notified technologies by MTAC, some are then referred to the DAP.
Dr Crabb said: “As a consequence of the sponsor notification process, we get informed of technologies the sponsor
thinks are important and innovative, where patients or the healthcare system can benefit. We also try to have a high general level of awareness of what’s going on out there to make sure we are keeping up to speed with major developments in the diagnostic area. We do this through horizon scanning,
participation in conferences, and so on.”
As with all NICE programmes, DAP evaluations are undertaken in accordance with published methods and processes. The DAP has published a programme manual on the NICE website that covers both the methods and processes.
Lessons learnt
A pilot was undertaken during 2010, with the infrastructure for the ongoing programme implemented in parallel with its progression. This meant that issues could be identified from the pilot experience and resolved in the early stages of the “live” programme.
Dr Crabb commented: “We were using experience of the pilot to write the detailed process and methods for the ongoing programme.”
“Perhaps the most important piece of learning, which has very much been incorporated into the ongoing programme, is the complexity of scoping for diagnostics. The scoping phase includes consideration of the alternative diagnostics to be included, the relevant conditions and patient populations for the evaluation, the care pathway to be used and the relevant outcomes to be estimated. For diagnostics this requires considerable research and expert clinical input. The DAP scoping phase has been designed to allow for this intensive activity in the light of the pilot experience.
Early days
The DAP is now fully up and running and has so far published three diagnostics guidance documents and has a further six topics at various stages through the process. Dr Crabb commented: “Although the programme is still in its relatively early days, feedback has been very positive and there is a high level of interest from a broad range of stakeholders.”
Dr Nick Crabb FOR MORE INFORMATION
Visit
www.nice.org.uk/media/A0B/97/ DAPManualFINAL.pdf
national health executive Mar/Apr 12 | 25 appropriate
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