Concept, skill and resource

Information about health technology assessment

Andrew Booth, Director of Information Resources, University of Sheffield, School of Health and Related Research, Sheffield, UK

Seeking HTA information

Health technology assessment is well served by electronic media, as evidenced both by compact disc and Interuet-based products. The contents these have to offer range from traditional bibliographic details through structured abstracts to the full text of selected reports and related publications. In making manageable what can be, for decision-makers, a bewildering array of resources, it is necessary to employ a 'best yield' strategy, starting with the most promising resources and working through less comprehensive, but no less important, sources. This challenge is complicated by the fact that, by definition, the HTA information-seeking trail differs significantly from the well-beaten routes commonly trodden by information specialists in hospital libraries.

Top choice 1: HealthStar Although a MEDLINE search will yield coverage of such key HTA joumals as the h~ternational Journal of Health Technology Assessment, Medical Care and Health Services Research, three sources are of particular value with the CD-ROM database of choice being another National Library of Medicine product, HealthStar.

Formed in 1996 from a consolidation of the HEALTH (Health Planning and Administration) and HSTAR (Health Services/Technology Assessment) databases, the complete backrun covers 2.43 million citations from the period of 1975 onwards. In addition to the journal literature, HeahhStar covers monographs, technical and governmental reports, together with meeting abstracts and conference papers so central to technology assessment. Much of this material has been specially indexed for the National Information Center on Health Services Research and Health Care Technology (NICHSR) [http://text.nlm.nih. gov/nichsr.htmll.

Top choice 2: DARE A much overlooked feature of the Database of Abstracts of Reviews of Effectiveness (DARE), part of the Cochrane Library and also available direct via telnet [tclnet:// nhscrd.york.ac.uk/insffcrd/info.htm] is its coverage of publications produced by members of the International Network of Agencies for Health Technology Assessment (INAHTA) network. It was founded in 1993 and now has 20 member agencies; all members are from non-profit organizations, operating at either a regional or national level of government with at least 50% public funding. Full details may be obtained from http:llwww.sbu.selsbu-sitellinkslinahtd index.html. Many of the member organizations have a separate presence on the World Wide Web, but the added value of DARE is in bringing the details of many scattered initiatives within a single database, in some instances providing indicative structured abstracts.

Top choice 3: HSTAT Third stop on the trail is Health Services/Technology Assessment Text (HSTAT), a database of full-text documents provided by the National Library of Medicine and available via a World Wide Web search gateway [http://text.nlm.nih. gov/ftrs/gateway]. Not to be confused with the similarly named HSTAR database mentioned earlier, access is provided to individual collections such as the Agency of Health Care Policy and Research Technology Assessments and Reviews or the National Institute of Health Consensus Statements or other US Web sites. Alternatively, users can search the whole collection by using text words or phrases.

Other important US-based resources include the archive of the now defunct Office of Technology Assessment which has a liberal sprinkling of health-related publications [http://www.wws.princeton.

© Ilarcourt Brace and Company Ltd 1993

edu:80/~ota/ns20/alpha-f.latml] and the Institute of Medicine [http://www2.nas. edu/iom/] with its collection of recently released reports. Within the not-for-profit sector, there is the important RAND site [htlp:llwww.rand.orglAbstractslabstraets. html], which has a searchable catalog and full-text versions or abstracts of several significant technology assessment texts such as Dissemination of Effectiveness and Outcomes Research and A Review of Health- Related Quality-of-Life Measures used in End-State Renal Disease.

Tile Finnish Guide to HTA Agencies

Perhaps the easiest way to get an international picture of health technology assessment is to check the excellent links page provided by FinOHTA, the Finnish Office for HTA [htlp:llwww.stakes.l'd finohta/linkiffe.html], which lists over 20 different international, national and regional links. However, within the context of information sources, it is necessary to draw a distinction between those that actually provide documents and those that provide organizational details. The following descriptions focus on the former but pointers to the latter are found in the Table.

UK Websites

Notwithstanding its absence from the above links pages, a major lntemet-based source for UK health technology assessment is the Wessex Institute for Health Research and Development. Broadly speaking, the Institute's activities operate at both national and regional levels.

At a national level, they collaborate with the University of York in running the National Co-ordinating Centre for Health Technology Assessment (NCCHTA), which coordinates the National Health Service HTA Programme [http://www.soton.ae.uk/ -,ai/hta/index.htnll]. NCCHTA have recently begun to make available the products of the program in the form of the Health Technology Assessment Reports Series. Abstracts have been provided for several reports while a new departure, in September 1997, is to provide full documents in Adobe Acrobat format [http:// www.soton.ac.uk/~~vi/hta/htapubs.html]. At a regional level, operating within the old Wessex and now the new South & West Regions, Institute staff support a Development and Evaluation Committee that, in turn, provides local guidance on new and existing technologies. This 'quick and clean' technology assessment has been

30 EVIDENCE-BASED HEALTH POLICY AND MANAGEMENT JUNE 1998

hformation about health technology assessment I

Table Examples of health technology agencies on the Web

Organization Country Address

Agence Nationale pour le Developpement France de l'Evaluation Medicale (ANDEM)

Agencia de Evaluaei6n de Tecnologfas as Spain Sanitarias (AETS)

Agency for Health Care Policy USA and Research

Canadian Coordinating Office for Health Canada Technology Assessment (CCOHTA)

Catalan Agency for ttealth Technology Spain Assessment

Danish Institute for Health Services Denmark Research and Development (DSi)

Finnish Office for Health Care Technology Finland Assessment (FinOHTA)

International Society of Technology International Assessment in Health Care (ISTAHC)

National Coordinating Centre for Health UK Technology Assessment (NCCHTA)

Scottish Health Purchasing Information Scotland Consortium (SHPIC)

Statens Beredning frr Utvardedng av Sweden medicinisk metodik (SBU)

Ziekenfondsraad Netherlands

http://www.upml.fr/andervdandem.htm

hnp:llwww.isciii.eslaetsl

http://www.ahepr.gov/

http://www.eeohta.ca/

http://www.aatm.es/

http://www.dsi.dk/

hup://www.stakes.fi/finohta/e/

http://www.istahc.org/

hnp://www.soton.ae.uk/-hta/

hnp://www.nhsconfed.net/shpic/

hnp://www.sbu.se/

hnp://www.zieken fondsraad.nl/

described in more detail elsewhere t but it will suffice to note that over 70 reviews have been coriducted covering topics as diverse as beta interferon for multiple sclerosis, counsellors in primary care and risperidone for schizophrenia. The majority is available as full-text documents from the World Wide Web, either in HTML, Microsoft Word 6 or Word 8 formats. The full list can be accessed at h t tp : / /coehrane .epi ,br i s .ac .uk/ rd / publ icaffdec/ index.htm. Similar initiatives exist in the Trent Working Group on Acute Purchasing [ht t p: / /www.shef.ae.uk/ ~schar r /dep t /publ i s t .h tml ] and the Scottish Health Purchasing Information Consortium [http: / /www.nhsconfed.neffshpic/] .

Canadian Websites

This distinction between HTA sources as national or regional holds for countries

outside the UK. In Canada, for example, there is a national body, the Canadian Co- ordinating Office for Health Technology (CCOHTA, "known also by its francophone acronym OCCETS). This is one of the most useful sites as it makes many publications available in full-text, again via Adobe Acrobat. Recent reports cover coronary stents, CT vs MRI scanners and sumatriptan for acute migraine. These can be accessed at h t tp : / /www.ccohta .ca /engl ish/pubs .h tm. Again the CCOHTA has an extensive links page at htlp:/ /www.ccohta.ca/englislv 'si tes. h tm. Canada also hosts one of the most developed regional agencies in the province- based British Columbia Office of Health Technology Assessment (BCOHTA). Their web pages can be found at h t tp : / /www. chspr .ubc .ca /bcoh la /and their extensive publications list includes a number of executive summaries.

The Swedish Websi te - SBU

No consideration of HTA sources is complete without mention of the Swedish agency, Statens beredning for medicinsk utvardering (SBU). Although perhaps not as prolific as other counterparts, SBU does have a disproportionately high number of materials available on the Internet, including a very readable newsletter and abstracts or full-text versions of many reports. It is particularly worth noting that one of the best introductions to the systematic review process, Literature Searchhlg and Evidence hzterpretation for Assesshlg Health Practices, z is available as full-text from the SBU site [http:/ /www.sbu.se/].

Conclusion

Health technology assessment information is particularly suited for dissemination via new technologies and is already present at a large number of sites. The critical absence of a 'one-stop shop' for all HTA information is attested to both in the variable quality of these sites and in the frequent duplication of topics. Nevertheless, it is true to say that coverage of materials for assessment of health technologies has never been better and that such improvements are likely to continue due to the relentless pace of health care innovation and the complementary development of the technology by which information is made available.

References

1. Best L, Stevens A, Colin-Jones D. Rapid and responsive health technology assessment: the development and evaluation process in South and West Region of England. J CIin Effect 1997; 2(2): 51-56

2. Goodman C. Literature searching and evidence interpretation for assessing health practices. Stockholm: Swedish Council on Technology Assessment in ltealth Care, 1993

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