44 We envisage two elements to the "catch up" programme:
   
 
i
 in response to completed assessments under the Department of Health's Health Technology Assessment (HTA) programme (or other HTA brought to the Department's attention). As each assessment is completed, the Department of Health will apply to the intervention in question the same selection criteria as those for new interventions (see Annex B). Interventions meeting the criteria will be automatically referred to the appraisal group, with the HTA assessment forming the central piece of evidence (this might need on occasion to be supplemented by some further analysis, which will either be commissioned from the original research group or from one of the regular assessment providers). The Department would need to ensure that this did not inadvertently give a competitive advantage to one product over another - though application of the suggested selection criteria should normally avoid this;
 
ii
 systematic prioritised catch up programme. Over a period of years, the Department will prioritise the most significant of existing interventions for appraisal, using a modified version of the selection criteria. In particular, interventions would (other things being equal) be more likely to be selected for appraisal if there was evidence of large and unexplainable variations in levels of use in the NHS, or evidence of use not in accordance with generally accepted good clinical practice. Where necessary, the Department will commission an assessment of the selected intervention through the NHS R&D programme.
     
45 In either case the appraisal process will be essentially the same as for new interventions. The appraisal group will however need to address the additional question of patients who are established on treatments which are subsequently shown not to be clinically cost effective, and under what circumstances clinicians should be encouraged to attempt to switch them to alternatives.
   
 

We would welcome views on these proposals, in particular

  • the need for both elements of the programme
  • the suggested selection criteria for each element