Identifying new health care technologies

Four methods are used: a systematic review of the literature on the methodology of predicting the future of health care; a semi-structured telephone enquiry of early warning system (EWS) coordinators from around the world; an international Delphi study to identify preferred sources for identifying new health care technologies; and retrospective case studies to illustrate how specific innovations could have been identified prior to their introduction and payback to the NHS of such early identification.A combination of the following information sources (many of which can now be accessed via the Internet) is recommended:* scanning of 'specialist' medical journals, key medical journals, Food & Drug Administration licensing applications in the UK, key pharmaceutical journals and conference abstracts, and liaison with pharmaceutical & biotechnology companies to produce a database of potential technologies, and * regular meetings and / or surveys involving sentinel groups of expert health professionals.The exact form of an EWS will ultimately depend upon the purposes for which the EWS is to be used and the policy environment within which it is expected to operate. Important general aspects of the operation of an EWS are:* continuity, so that the important monitoring function of an EWS can be performed on those technologies which have a long development phase;* that only a relatively small core staffing is required as long as there is access to experts either through formal committee structures or regular surveys;* the need for collaboration with existing national and international programmes with the aim of ensuring adequate coverage of all types of technologies and providing sufficient early warning; and * that an EWS should be part of a national HTA programme in order to allow health technology assessment (HTA) research to be commissioned or run in parallel alongside early clinical trials.The overall value of an EWS for HTA purposes should be judged by the extent to which it facilitates timely research-based evidence on new technologies. The assessment of the likely 'payback' to the NHS from EWS-instigated research on the nine case-studies suggests a number of important potential benefits. Suggestions for realising and increasing the value of an EWS in the context of recent policy developments in the UK are presented.