What Is the Best Approach?

No single priority setting method is obviously superior to others (Goodman, 2004; Noorani et al., 2007; Oxman et al., 2006; Sassi, 2003). The committee could not find any systematic assessments of the comparative strengths and weaknesses of different approaches to priority setting, including whether complex quantitative and resource-intensive methods are more effective than less rigorous approaches.

Apparently, few, if any, organizations use a quantitative approach to selecting priority topics, although numerous methods have been developed. Phelps and Parente (1990), for example, developed a formula for calculating a priority index for health technology assessment. The Institute of Medicine (IOM) Committee on Priorities for Assessment and Reassessment of Health Care Technologies proposed a method that could be used to aggregate various dimensions into a single priority score, including a technique that quantifies the potential gains that can achieved by assessing health interventions (IOM, 1992).1

Various Contexts for Setting Priorities

Organizations have different objectives and target audiences for evidence assessment. The annual number of selected topics that are reviewed is quite small (Table 3-1). In 2006, for example, the number of systematic reviews produced by federal agencies ranged from only 3 by the National Institutes of Health (NIH) Consensus Development Program to 22 by the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Centers (EPCs). There are no aggregate national data on the volume of topics that are assessed each year.

The range of potential topics that may be considered may include the universe of prevention such as screening tests or immunizations, diagnosis such as laboratory tests or imaging techniques, drugs and other therapeutic interventions such as surgery, chemotherapy, or radiation, and end-of-life care and palliation. However, the specific audience for the assessment is likely to have more narrow interests, such as new and emerging technologies or a specific subpopulation group. For example, the Blue Cross and Blue Shield Association (BCBSA) Technology Evaluation Center (TEC) focuses on the specific needs of member plans. The Medicare Evidence Development and Coverage Advisory Committee (MedCAC), which advises

1

See the following IOM reports for past recommendations related to priority setting: Setting Priorities for Health Technologies Assessment: A Model Process (IOM, 1992), Setting Priorities for Clinical Practice Guidelines (IOM, 1995), National Priorities for the Assessment of Clinical Conditions and Medical Technologies: Report of a Pilot Study (IOM, 1990), and Priority Areas for National Action: Transforming Health Care Quality (IOM, 2003).



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