Michael Drummond

Professor of Health Economics at University of York Centre for Health Economics

Author of: What are the HTA processes in the UK?

Mike is Professor of Health Economics and was Director of the Centre from December 1995 to September 2005. His particular field of interest is in the economic evaluation of health care treatments and programmes. He has undertaken evaluations in a wide range of medical fields including care of the elderly, neonatal intensive care, immunisation programmes, services for people with AIDS, eye health care and pharmaceuticals.

He is the author of two major textbooks and more than 600 scientific papers, has acted as a consultant to the World Health Organization and was Project Leader of a European Union Project on the Methodology of Economic Appraisal of Health Technology. He has also served on the Boards of Directors of the International Society of Technology Assessment in Health Care and the International Society for Pharmacoeconomics and Outcomes Research. He has been President of the International Society for Pharmacoeconomics and Outcomes Research. He is currently Co-Editor-in-Chief of Value in Health.

Professor Drummond has been awarded two honorary degrees, from City University, London (2008) and Erasmus University, Rotterdam (2012).  In 2010 he was made a member of the Institute of Medicine of the National Academies in the USA, being one of only 27 members from the UK.   Mike Drummond is the recipient of The John Eisenberg Award, in recognition of exemplary leadership in the practical application of medical decision-making research, by the Society for Medical Decision Making at its annual conference in Phoenix AZ, USA, October 2012.

His recent projects relate to the conduct of economic evaluations and their use in health care decision making. These include:

  • NHS Economic Evaluation Database (funded by NHS R&D)
  • Assessment of the socio-economic value of medical devices (funded by the European Health Technology Institute)

Summary: What are the HTA processes in the UK? 

  • Health technology assessment (HTA) has a long history in the UK. In recent years HTA has become synonymous with the activities of the National Institute for Health and Care Excellence (NICE) in England, although important entities also exist in Scotland – the Scottish Medicines Consortium (SMC) – and Wales – the All Wales Medicines Strategy Group (AWMSG).
  • The NICE technology appraisals programme develops guidance on the use of new and existing medicines, treatments and procedures within the NHS.
  • NICE commissions so-called technology assessment groups to prepare assessment reports for consideration by the Technology Appraisal Committee (TAC), which is the primary decision making body in the production of guidance on new health technologies. The TAC includes academics, healthcare professionals, NHS managers and commissioners, and lay members of the public; the appraisal of the specific technology includes representatives of the manufacturer and of the patients affected.
  • Guidelines on the methods of technology appraisal, which have been issued by NICE, embody the concept of the reference case.
  • There are two approaches to technology appraisals: multiple technology appraisals (MTAs) for the evaluation of all the relevant technologies for the same indication and single technology appraisals (STAs) for the evaluation of single technologies for a sole indication.
  • MTAs started as the standard approach, taking 54 weeks from initiation of the process. In an MTA, the independent evidence assessment group reviews the evidence base and develops its own independent effectiveness and cost-effectiveness assessment, as well as critically appraising submissions from manufacturers or sponsors of the technologies.
  • STAs are currently the most common approach, taking 39 weeks from initiation. In an STA, the manufacturer or sponsor of the technology submits evidence on its effectiveness and cost-effectiveness; the independent evidence review group critically appraises the submission.
  • Advantages of NICE’s approach to technology appraisals include its methodological rigour, the encouragement of extensive stakeholder involvement and transparency of the appraisal process.
  • Issues of concern are a lack of independence of NICE from the government, timeliness of the assessments, the use of a cost-effectiveness threshold, the use of the quality-adjusted life-year as a measure of health benefit, and the uneven implementation of NICE guidance across the NHS.
  • The HTA procedures in Scotland and Wales are more timely, but the SMC and AWMSG face many of the other challenges also faced by NICE.