the United States evaluates from a broad, national perspective the effectiveness of new as well as established health interventions for all populations, children as well as elderly people, women as well as men, and ethnic and racial minorities.

As noted in Chapter 1, this report focuses on developing an organizational framework for a national clinical effectiveness assessment program, referred throughout as “the Program.” Early in its deliberations, the committee agreed that the Program should commission systematic reviews on the effectiveness of health services and that the topics of the reviews should be informed by the recommendations of an independent Priority Setting Advisory Committee (PSAC). The objective of this chapter is threefold: (1) to review the basic elements of a priority setting process, (2) to present the committee’s recommendations for establishing a priority setting infrastructure, and (3) to highlight key programmatic challenges in establishing a priority setting process for the Program.

This section provides background on the basic elements of a priority setting process: identifying potential topics, selecting the priority criteria, reducing the initial list of nominated topics to a smaller set of topics to be pursued, and choosing the final priority topics. Some approaches also incorporate quantitative methods that involve the collection of data that can be used to weigh priorities, the assignment of scores for each criterion to each topic, and the calculation of priority scores for each topic to produce a ranked priority list. A committee or advisory group that reviews and chooses the topics that will be funded typically conducts the process. It may use a formal method, such as the Delphi technique, to systematically develop the high-priority list. The Delphi technique has been adapted and modified in various ways to facilitate group decision making (OTA, 1994). It typically involves the distribution of a questionnaire to an expert group. Each participant independently answers the questionnaires. The responses are summarized and reported back to the group. The process may be anonymous or open, and several iterations may be necessary before a final decision is reached.