- What is a Short HTA?
- What is the purpose of the Short HTA on the use of B-type natriuretic peptide in the investigation of patients with suspected heart failure?
- How will the assessment be carried out?
- How will the report affect patient care?
- How was this topic selected for assessment?
- Who will be involved?
- Who should I contact about this assessment?
What is a Short HTA?
Health Technology Assessment (HTA) is a process used by NHS Quality Improvement Scotland (NHS QIS) to advise the NHS in Scotland about a specific health intervention (e.g. medicine, equipment or diagnostic test). HTA evaluates the clinical and cost effectiveness of the various ways in which the health intervention can be used, comparing alternative interventions where appropriate. Patient and organisational aspects, including professional, legal and ethical issues are considered in detail.
At the end of all assessments, recommendations are made to NHSScotland. These are published in a comprehensive assessment report accompanied by a short summary suitable for people without specialist knowledge of the topic. The report and summary are made available to health professionals and the public. The recommendations are evidence based but value judgements are also made following discussion with experts.
It is recognised that some topics require less thorough investigation and have a narrower focus than others, perhaps with few organisational or patient issues. Consequently NHS QIS has developed a new process called a Short HTA.
What is the purpose of the Short HTA on the use of B-type natriuretic peptide in the investigation of patients with suspected heart failure?
Heart failure is a complex syndrome in which the ability of the heart to function as a pump is impaired. It is one of the main reasons for hospitalisation in Scotland and is associated with high mortality. There are a number of causes of heart failure and the prevalence is highest in elderly people. It is characterised by symptoms such as breathlessness, fatigue and fluid retention, although in many cases there are no symptoms.
Timely recognition can improve the outcome as effective treatment can be started. Diagnostic tests such as ECG and chest X-ray can be unreliable and as many as 50% of patients who are diagnosed in primary care as having heart failure do not actually have the syndrome when echocardiography (the ?gold standard? test for heart failure) is undertaken.
There is evidence that a blood test which measures B-type natriuretic peptide (BNP) or N-terminal pro BNP (NT-Pro-BNP, peptide hormones produced in the heart, aids the diagnosis of heart failure because plasma BNP or NT-Pro-BNP concentrations are raised in patients with heart failure. This Short HTA will test whether or not a negative BNP or NT-Pro-BNP result can reliably rule out heart failure and whether or not a positive result can increase the accuracy of diagnosis.
The aim of this Short HTA is to establish the place of BNP or NT-Pro-BNP in the diagnosis of heart failure in Scotland and determine the associated costs and benefits of the strategy which will be recommended as a result of the assessment.
How will the assessment be carried out?
Health Technology Assessment is an internationally recognised process. Evidence identified by literature searching together with evidence provided by experts, patient interest groups and manufacturers will be critically appraised and robust analyses will be undertaken by expert staff. Questionnaires may be undertaken to ascertain current clinical practice and patient preferences.
NHS QIS staff from a variety of disciplines will conduct the assessment and will also seek advice from health professionals who are expert in this area of medicine.
There will be a consultation period during which a draft report and recommendations will be published on this website. Anyone with an interest in the topic will be invited to submit comments. All comments will be given due consideration and the report will be updated accordingly.
How will the report affect patient care?
The results of the assessment will be used as the basis of recommendations for NHSScotland on the use of BNP or NT-Pro-BNP. It will then be up to health professionals in NHSScotland to ensure that these recommendations are put in to practice.
How was this topic selected for assessment?
There is increasing interest from general practitioners and hospital physicians in Scotland about the use of BNP or NT-Pro-BNP, but uncertainty about whether and how it should be used. Professor H J Dargie, a Consultant Cardiologist at the Western Infirmary in Glasgow, proposed the topic in order to clarify the clinical and cost effectiveness of the BNP or NT-Pro-BNP blood test.
Who will be involved?
The assessment will be undertaken by a multidisciplinary team of NHS QIS staff. The following people have agreed to provide expert advice:
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Dr David Davidson, General Practitioner, Paisley
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Dr Hamish Greig, General Practitioner, Brechin Medical Practice
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Dr Andrew Henderson, General Physician, Lorn & Islands District General Hospital
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Dr Theresa McDonagh, Senior Lecturer (Clinical) in Medical Cardiology and Honorary Consultant Cardiologist, Glasgow Royal Infirmary
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Ms Elizabeth Paton, Heart Failure Project Nurse, East Ayrshire LHCC
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Dr Alan Reid, Biochemist, The Victoria Infirmary Glasgow
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Dr Richard Spooner, Department of Biochemistry, Gartnavel General Hospital, Glasgow
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Prof Allan Struthers, Professor of Cardiovascular Medicine & Therapeutics, Ninewells Hospital Medical School Dundee
Additionally, the following people will peer review the report and recommendations:
- Dr Paul Collinson Consultant Chemical Pathologist, St George?s Hospital London
- Professor Martin Cowie, Chair in Cardiology, Imperial College London
- Dr Frank Dunn, Clinical Director, Stobhill Hospital Glasgow
- Dr Steve Engleman, Health Economist, Independent Consultant
- Dr Paul Padfield, General Physician, Western General Hospital Edinburgh
Who should I contact about this assessment?
The assessment is being led by Ms Joyce Craig who would welcome any enquiries (see contact details below):
Ms Joyce Craig
Senior Health Economist
NHS Quality Improvement Scotland
Delta House
50 West Nile Street
Glasgow G1 2NP
Tel: +44 (0)141 225 6985
E-mail: joyce.craig@nhshealthquality.org
NHS QIS invites comments regarding the proposed scope of the assessment and would welcome any submissions of evidence relating to the topic.