TABLE 3-6 Definitions of Commonly Used Priority Setting Criteria

Criterion

Definition

Disease burden

Extent of disability, morbidity, or mortality imposed by a condition, including effects on patients, families, communities, and society overall

Controversy

Controversy or uncertainty around the topic and supporting data

Cost

Economic cost associated with the condition, procedure, treatment, or technology related to the number of people needing care, unit cost of care, or indirect costs

New evidence

New evidence with the potential to change conclusions from prior assessments

Potential impact

Potential to improve health outcomes (morbidity, mortality) and quality of life; improve decision making for patient or provider

Public or provider interest

Consumers, patients, clinicians, payers, and others want an assessment to inform decision making

Sufficient evidence

The available research literature provides adequate evidence to support an assessment

Variation in care

Potential to reduce unexplained variations in prevention, diagnosis, or treatment; the current use is outside the parameters of clinical evidence

reviews focused primarily on pharmaceuticals (40 percent) and surgical procedures (16 percent) and overrepresented cerebrovascular disease, diabetes, breast cancer, and HIV/AIDS, whereas they underrepresented depression and bipolar disorder, injuries, and substance abuse disorders. Similarly, a survey of European horizon-scanning agencies found little evidence that the organizations had operationalized all of their selection criteria (Douw and Vondeling, 2006).

FINDINGS

There is little solid basis at present for judging whether one method of selecting priorities is better than another. The Cochrane Collaboration and the USPSTF are currently reconsidering their approaches and may have insights to offer in the future (Cochrane Collaboration, 2007; Guirguis-Blake et al., 2007). Although AHRQ has handled a relatively small volume of nominations, it has considerable experience managing topic nominations for its effectiveness programs. The Program should learn from this experience.

New and emerging technologies are clearly high priorities for health



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