Diagnostics is not Cinderella of health technology assessment

Editor—Furness makes an important point about the lack of emphasis on diagnostics but ironically has the wrong diagnosis.¹ As we tried to make clear in our editorial,² there is a long chain from health technology assessment (the scientific summation of evidence about effectiveness) through appraisal (the policy related judgments that the National Institute for Health and Clinical Excellence (NICE) and others then make on the basis of the assessments) to the implementation and availability of services. The neglect of diagnostics lies not with health technology assessment but further along the chain.

The NHS programme for health technology assessment has given much attention to diagnostics. Although health technology assessment covers all healthcare interventions from health promotion through disease prevention, diagnosis, treatment, and rehabilitation through to continuing care, the programme has devoted one of its four expert panels (until this year, one of only three) entirely to diagnostics and screening. The programme has published 36 monographs about diagnostic technologies and has commissioned a further 32 research projects that are now under way.

As we highlighted in our editorial, the assessment of diagnostics poses some particularly difficult methodological challenges. Clearly, however, there is an even greater challenge to ensure that once a diagnostic technology has been assessed as cost effective it is made properly and widely available in the NHS. If we are to tackle that problem, then let us at least understand where and how it is happening, rather than jumping to blame the wrong part of the system.