Boos, Norbert

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EDITORIALHealth care technology assessment and transferNorbert BoosAccepted: 2 July 2007 / Published online: 18 July 2007 Springer-Verlag 2007Financing a national health care system has become aneminent societal and political issue in industrializedcountries. Today, patients are well informed and demandfor a full, immediate access to the whole spectrum ofavailable health care resources. Simultaneously, com-plaints on the high costs are rising. Reallocation orrestrictions of resources are being discussed to solve thehealth care conundrum.Spinal surgery is predominantly focusing on theimprovement of health-related quality of life and in mostcases not a lifesaving intervention. Therefore, spinal sur-gery, theoretically, is dispensable in the vast majority ofcases. At the same time, spinal surgery is one of the mostrapidly growing surgical disciplines in medicine, substan-tially increasing health care costs. Spinal surgery maycome more and more into the focus of politicians when re-allocation of resources is prompted. This has alreadyhappened in Switzerland, where total disc arthroplasty(TDA) was stopped by a health political moratorium. Onlyafter a formal health technology assessment and theinstalment of a nationwide quality control system in theform of a spine registry, reimbursement for TDAs wasrestarted. Meanwhile, kyphoplasty and dynamic stabiliza-tion were scrutinized in a similar fashion in Switzerland.Eurospine, the Spine Society of Europe has decided totake on a proactive role and inaugurated a Committee forHealth Technology Assessment and Registry dedicated tothese issues on a European level. In a context of scarceresources in the health care sector, treatment decisionsand particularly the choice of costly technology should bebased on scientific evidence. When new health technolo-gies are introduced an evidence-based approach is notpossible for obvious reasons. On the other hand, newpromising technology cannot be retained for years untilsufficient scientific evidence is generated. However, astructured process of technology transfer from the benchto the bedside can be started using so-called healthtechnology assessments (HTAs). The International Net-work of Agencies for Health Technology Assessmentdefines HTA as ‘‘a systematic evaluation of properties,effects, and/or impacts of healthcare technology. It mayaddress the direct, intended consequences of technologiesas well as their indirect, unintended consequences. Itsmain purpose is to inform technology-related policymak-ing in health care. The HTA is conducted by interdisci-plinary groups using explicit analytical frameworksdrawing from a variety of methods’’ [1]. As indicated bythis definition, HTAs seek the best available evidence toallow for an informed structured decision making on newmedical technology. In this process, HTAs do not onlyconsider technical properties, safety, clinical effectivenessand economic impact but also try to see the new tech-nology in a wider perspective, i.e., take into accountsocietal impact, social and ethical consequences as well aspolitical implications [3, 7]. Eurospine has decided topromote and create awareness for HTAs in spinal healthcare. Full HTAs are time and cost consuming and oftendo not provide the required information on new technol-ogy in a timely manner. Rapid HTAs can fill in that gapand are useful as a provisional appraisal [4]. Eurospinewants to foster such rapid HTAs for emerging technologysuch as, e.g., interspinous spacers or nucleoplasty, therebyN. Boos (&)Centre for Spinal Surgery, University of Zurich,Uniklinik Balgrist, Forchstrasse 340,8008 Zurich, Switzerlande-mail: norbert.boos@mysmx.ch123Eur Spine J (2007) 16:1291–1292DOI 10.1007/s00586-007-0440-9providing a model role on how a society can activelyinfluence the introduction and spreading of new technol-ogies.As the official publication of Eurospine, the EuropeanSpine Journal has responded to the needs of Eurospine andcreated a dedicated section in the Journal on ‘‘HealthTechnology Assessment and Transfer’’. In this issue, westart this new section with an overview article by Herndon,Hwang and Bozic on ‘‘Health Technology and TechnologyAssessment’’. The article is based on the guest lecture ofJames H. Herndon during the HTA symposium at the 2006Eurospine meeting in Istanbul. Dr. Herndon is one of themost distinguished American orthopedic surgeons with animpressive track record of achievements, who was alwaysin the forefront in pinpointing unaddressed problems suchas, e.g., adverse events in surgery [5, 6]. Together withKevin J. Bozic and Read G. Pierce, he first communicatedthe important role of HTAs in the orthopedic community[2]. In the present article, Herndon et al. [5] discuss forcesthat drive the introduction of new technology and providean overview on the basic principles of HTAs. The articlealso highlights the necessity for a comprehensive analysisof risks, benefits and costs before a new technology isavailable for general use by physicians.In this new journal section, we do not only intend tocommunicate HTAs of spinal treatments and technologiesbut we also want to highlight political issues associatedwith the introduction of new technologies. The HTAsshould build a bridge between health science on one sideand health politics on the other side. This new sectionshould create the awareness for the need for and potentialof HTAs. Health technology assessments should allow fora structured, rationalized and cost-containing approachwhen introducing new technologies. The final goal is toallow for a rapid adoption of new technology, which issuperior and abandon those new techniques, which areinferior or less safely compared to existing treatments.Finally, HTA may thereby prevent retention of newpromising technology and contribute to a continuousimprovement of spinal health care.References1. Anonymous (2006) HTA glossary. http://www.inahta.org2. Bozic KJ, Pierce RG, Herndon JH (2004) Health care technologyassessment. Basic principles and clinical applications. J Bone JointSurg Am 86(A):1305–13143. Draborg E, Gyrd-Hansen D (2005) Time-trends in health technol-ogy assessments: an analysis of developments in composition ofinternational health technology assessments from 1989 to 2002. IntJ Technol Assess Health Care 21:492–4984. Hailey D, Corabian P, Harstall C, Schneider W (2000) The use andimpact of rapid health technology assessments. Int J TechnolAssess Health Care 16:651–6665. Herndon JH, Tipton WW Jr, Wong DA (2003) Approaches toavoiding wrong site surgery. Am J Orthop 32:274; author reply274–56. Hwang RW, Herndon JH (2007) The business case for patientsafety. Clin Orthop Relat Res 457:21–347. ten Have H (2004) Ethical perspectives on health technologyassessment. Int J Technol Assess Health Care 20:71–761292 Eur Spine J (2007) 16:1291–1292123

Health care technology assessment and transfer

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Health care technology assessment and transfer

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