Setting Priorities for Health Technologies Assessment A Model Process (1992) / Chapter Skim
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APPENDIX A: A PILOT TEST OF THE IOM MODEL
APPENDIX A: A PILOT TEST OF THE IOM MODEL
Pages 136-145
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From page 136... ...
The mailed pilot test used the criterion definitions developed by the convened group to weight the criteria and provided criterion scores for the three subjective criteria. In addition to the weighting and criterion scoring activities, each group listed the ethical, legal, and social problems that contributed to their rating of that criterion.
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From page 137... ...
These definitions required a designation of whether the condition or technology was to include prevention, screening, diagnosis, or treatment; the level of severity; the care settings; and the anatomical site or sites of interest. For instance, "cardiovascular disease" in the IOM/CHCT study was further defined for this pilot test as "treatment of coronary artery disease severe enough to consider revascularization but not treatment of post-myocardial infarction." Thus, the individual topics in the pilot test were a subset of the topics listed in the IOM/CHCT report but not strictly comparable to them.
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From page 138... ...
The mailed pilot test group was not asked to provide objective criterion scores. Consequently, in order to compare priority scores for both groups, the analysis used the criterion scores that the convened pilot group assigned to each criterion (as well as the convened pilot criterion weights)
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From page 139... ...
Figure A.2 shows the mean criterion weights and standard deviations derived by the mailed pilot group. Overall, the mailed pilot group assigned higher individual criterion weights and had a greater range of weights relative to the ELS criterion than were assigned by the
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From page 140... ...
Criterion scores for the three subjective criteria (burden of illness, likelihood of an assessment changing health outcomes, and probability of resolving an ELS issue) were compared for each condition or technology.
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From page 141... ...
It is useful to examine how the model behaves when criterion scores vary (Figure A.4~. To test how changes in subjective ratings affect the final priority score, one can hold constant the criterion weights and the objective 4 3 o ._ ~ 2 ._ Can 1 o 1 1 1 Burden Outcome Prevalence Vanation Cost ELS Figure A.2 Mean criterion weights and their standard deviations for the mailed pilot group; ELS=ethical, legal, and social (issues)
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From page 142... ...
,.. Cnterion scores for burden of illness, outcomes, and ELS varied Cnterhn scores for burden of illness and outcomes varied Cnterion scores for burden of illness varied 1 2 3 4 Subjective Criterion Score Figure A.4 Effect of `rarying the subjective criterion scores on the priority score; ELS=ethical, legal, and social (issues)
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From page 143... ...
, substantial changes in the mean criterion score for a given condition affect the final priority score. IMPLICATIONS OF THE PILOT TESTS FOR THE IOM MODEL Neither group reported difficulties in assigning criterion weights, although the group surveyed by mail reported difficulty in assigning subjective criterion scores for individual conditions or technologies.
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From page 144... ...
Another individual, who gave a rating of 1 to ELS issues, explained, "I seriously doubt new technology is as important as prevention." In considering the burden of illness from cataracts, one person persuaded the group that untreated cataracts could mean the difference between living independently and requiring nursing home care. Another person considered the burden to society of highway accidents related to cataract-impaired drivers.
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From page 145... ...
Although the number of individuals in each group was small, the two pilot tests suggest that implementation of the model will require very clear and careful descriptions of the criteria as well as several rounds of voting and discussion conducted in conference or by other methods to establish criterion weights. Some criteria, such as prevalence, are familiar to many people but are used in this model in specific ways, particularly when referring to procedures and screening technologies.
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