The aim of this article is to review the role of Health Technology Assessment (HTA) organisations in appraising and recommending innovative cardiovascular technologies. We consider how bias impairs the quality of evidence from clinical trials involving cardiovascular healthcare technologies. Finally, we provide recommendations to HTA organisations to take account of bias when making guideline recommendations.
Clinical research studies of medical devices, diagnostics and interventions in cardiovascular healthcare are susceptible to impairment through bias. While HTA organisations, such as the National Institute of Health and Care Excellence, may require reviewers to take account of bias, there are uncertainties as to how this is achieved, especially in cardiovascular technology trials. This becomes more relevant given that large trials are few in number; therefore, the quality of evidence from an individual trial may have a large bearing on guideline recommendations and clinical practice.
HTA organisations should drive improvements in the design and rigour of randomised trials. The evolving landscape of cardiovascular healthcare technologies and related trials presents a challenge for HTA organisations and healthcare providers. The rapid turnover of evidence is externally relevant because the period from the trial publication to implementation of HTA guideline recommendations by healthcare providers may be prolonged, by which time new evidence may have emerged from subsequent trials. Implementation of a cardiovascular healthcare technology including be it a medical device, diagnostic or intervention may have profound implications for healthcare providers. These technologies may have high absolute costs and access may be influenced by socioeconomic and geographic factors.
- coronary artery disease
- imaging and diagnostics
- public health
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Twitter @ColinBerryMD @kenneth_mangion
Contributors CB conceived the idea.KM, DSC and CB drafted the article and reviewed it for intellectual content.
Funding This article was funded by British Heart Foundation and the grant number is S/14/15/30661FS/15/54/31639PG/14/64/31043RE/13/5/30177.
Competing interests CB is named on institutional research and/or consultancy agreements between the University of Glasgow and Abbot Vascular, AstraZeneca, Coroventis, Corstem, GSK, HeartFlow, Menarini, Neosoft, Novartis, Philips and Siemens Healthcare. These companies had no involvement in this manuscript. The authors have no affiliation with any Health Technology Assessment organisation. There are no other potential conflicts of interest.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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