Setting Priorities for Health Technologies Assessment A Model Process (1992) / Chapter Skim
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6 RECOMMENDATIONS AND CONCLUSIONS
6 RECOMMENDATIONS AND CONCLUSIONS
Pages 115-130
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From page 115... ...
and by other assessment organizations. In responding to this charge, the committee organized its work and this report at three levels of specification: general principles, a proposed process, and information about how to implement the process within OHTA and in other organizations Hat conduct health technology assessment.
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From page 116... ...
Several specific benefits of an OHTA priority-setting process include the potential to improve the health and well-being of the public, reduce needless or inappropriate health expenditures, reduce inequities and maldistribution of health care, and inform ethical, legal, and social issues related to candidate topics. The committee enunciated three other objectives of a pnority-setting process: it must (1)
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From page 117... ...
The data required to determine the assessment priority of a clinical condition depend on which technologies are relevant to its management. (For example, the expected cost of managing a condition depends on the costs of the individual technologies that might be used.)
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From page 118... ...
The committee also recommends the following subjective criteria: · burden of illness imposed by the clinical condition; · potential of the results of the assessment to change health outcomes; · potential of the results of the assessment to change costs; and · potential of the results of the assessment to inform ethical, legal, or social issues. Although some objective data about these criteria may exist, integration of these data often requires subjective estimates as well as judgments about the likely effect of an assessment; thus, the committee considers these four criteria subjective.
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From page 119... ...
Use of a quantitative model as part of this process allows assumptions to be explicitly stated and individually assessed; it also permits the use of data, whenever they are available. Recommendation 6 The committee recommends a specific quantitative method to calculate a priority score for each candidate topic, using the following formula: Prioritv Score = W~lnSl + W21nS2 ~ .
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From page 120... ...
Practical approaches include preliminary ranking according to one or two of the objective criteria or a consensus process in which several groups would subjectively rank subsets of candidates by mail ballot Recommendation 9 OHTA should consider all previously assessed topics as candidates for reassessment. OHTA has a special obligation as an influential public agency to revisit any previously assessed topics whose recommendations may be based on
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From page 121... ...
Recommendation 10 OHTA should maintain a data base on each topic that has been previously assessed and should catalog information pertaining to the topic. A catalog will make it easier for OHIA to know when to consider topics for reassessment and when newly published information is relevant to a topic that has been previously assessed.
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From page 122... ...
Steps in a Priority-Setting Process Step 1. Selecting and Weighting the Criteria Used to Establish Priority Scores This step requires that a broadly representative panel be constituted to select and define the criteria to be used for priority setting.
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From page 123... ...
Step 6. Computing Priority Scores The quantitative model developed by the committee and presented in Chapter 4 combines empirical rates (objective criterion scores)
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From page 124... ...
Throughout the 3-year cycle, OHTA program staff would be responsible for tracking information related to previous assessments. Publicly Available Products The committee views the priority-setting process as a public good that will be one of OHTA's most valued products; thus, OHTA should generate a list of priorities for assessment that is extensive enough for use by other organizations that perform technology assessment.
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From page 125... ...
The more they structure their technology assessment activities, including priority setting, as a public service, the greater the good they will do for their own private purposes and for their mission of public service. By focusing on clinical conditions rather than on individual technologies, the*
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From page 126... ...
A1though the prionty-setting process could simply involve implicit judgments about how well a candidate topic meets explicit criteria, an explicit method for determining priority rankings is better than an implicit method at satisfying the requirement for openness. · The process of soliciting nominations is one element of an ideal process that could be designed to satisfy the needs of a specific organization without compromising the public interest.
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From page 127... ...
, are "systematically developed statements to assist the practitioner and patient in decisions concerning appropriate health care for specific clinical circumstances." This and a forthcoming IOM report, Guidelines for Clinical Practice: From Development to Use, call attention to the following needs: information on costs and outcomes; a rigorous, open, and documented development process; a broadly representative, multidisciplinary process of development and review; and a systematic plan for scheduled review and reassessments. Clinical practice guidelines are one vehicle for disseminating the results of technology assessment, and technology assessment is one method of producing information for a practice guideline.
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From page 128... ...
But a criterion score is precise only if it has a small coefficient of variation across all panel members. The risk of imputing false precision to a priority score is that it may lead to erroneous inferences that one of two candidates with similar (but not identical)
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From page 129... ...
In the case of OHTA, satisfying the first principle will require determining which assessments are most likely to result in improvement in the health of the public, reduction of inappropriate health care expenditures, reduction of inequities in access to effective health care services or of maldis~ibution across equally needy populations, and the informing of other ethical, legal, and social issues. OHTA and other organizations may wish to modify some of the components of the process as proposed.
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From page 130... ...
The committee views its report as a strategic effort to look ahead to reasonable goals for AHCPR and OHTA and to create a process that will be credible, sound, and defensible. Dunng the process of compiling data for the quantitative model, OHTA will create a valuable data base and a ranking of priorities; both will be important resources for other organizations as well as for OEIA itself.
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