Setting priorities for health technology assessment : a model process / Molla S. Donaldson and Harold C. Sox, Jr., editors.

Format:

Book

Contributor:

Donaldson, Molla S.

Sox, Harold C.

Language:

English

Subjects (All):

Medical technology--United States--Evaluation.

Medical technology.

Technology assessment--United States.

Technology assessment.

Physical Description:

1 online resource (162 p.)

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, 1992.

Language Note:

English

Summary:

The problem of deciding which health care technologies to evaluate is urgent. With new technologies proliferating alongside steadily increasing health care costs, it is critical to discriminate among technologies to direct tests and treatments at those who can benefit the most. Given the vast number of clinical problems and technologies to be evaluated, the many months of work required to study just one problem, and the relatively few clinicians with highly developed analytic skills, institutions must set priorities for assessment. This book sets forth criteria and a method that can be used by public agencies such as the Office of Health Technology Assessment (in the U.S. Public Health Service) and by any private organization conducting such work to decide which technologies to assess or reassess.

Contents:

SETTING PRIORITIES FOR HEALTH TECHNOLOGY ASSESSMENT

Copyright

Acknowledgments

Contents

Preface

Summary

RATIONALE

METHODS OF PRIORITY SETTING

GUIDING PRINCIPLES

THE PROCESS PROPOSED BY THE IOM COMMITTEE

Steps in the Process

Seven Criteria

Reassessment

The Priority-Setting Cycle

Human Resources Required to Implement the Process

Publicly Available Products

Topics for Which There is Insufficient Evidence to Conduct an Assessment Based on Review of the Literature

RECOMMENDATIONS

Recommendation 1

Recommendation 2

Recommendation 3

Recommendation 4

Recommendation 5

Recommendation 6

Recommendation 7

Recommendation 8

Recommendation 9

Recommendation 10

Recommendation 11

ADOPTION OF THE IOM'S PRIORITY-SETTING PROCESS BY OTHER ORGANIZATIONS

Technology Assessment and Clinical Practice Guidelines

POTENTIAL PROBLEMS WITH THE PRIORITY-SETTING PROCESS

CONCLUDING REMARKS

1 Technology Assessment and the Need for Priority Setting

EVOLUTION OF TECHNOLOGY ASSESSMENT TOWARD OUTCOMES, EFFECTIVENESS, AND APPROPRIATENESS RESEARCH

The Effectiveness Initiative and Establishment of the Agency for Health Care Policy and Research

The Office of Health Technology Assessment

ORIGIN OF THE IOM STUDY

Previous Pilot Study of Preliminary Model

STUDY METHODS

DEFINITIONS

Medical Technology

Technology Assessment

REPORT STRUCTURE

SUMMARY

APPENDIX: THE AGENCY FOR HEALTH CARE POLICY AND RESEARCH

Center for Medical Effectiveness Research

Office of the Forum for Quality and Effectiveness in Health Care

Office of Science and Data Development

Center for General Health Services Extramural Research and the Division of Technology and Quality Assessment

Office of Health Technology Assessment

OHTA Technology Assessments.

2 Methods for Priority Setting

PRIORITY-SETTING PROCESSES USED BY ORGANIZATIONS

Example 1: Health Care Financing Administration

Bureau of Policy Development

Health Care Financing Administration Physicians Panel

Reevaluation or Assessment of Established Technologies

Example 2: Private Sector-Pharmaceutical Industry

Criteria for Assessment

Criteria for Reassessment

Internal Process of Priority Setting

Example 3: Health Care Provider Organizations

Example 4: Institute of Medicine/Council on Health Care Technology Pilot Study

Example 5: Food and Drug Administration

QUANTITATIVE MODELS FOR SETTING PRIORITIES

Example 6: Technology Assessment Priority-Setting System

Example 7: The Phelps-Parente Model

SETTING PRIORITIES FOR SPENDING ON HEALTH SERVICES

Example 8: Oregon Basic Health Services Act

DISCUSSION

Reactive and Implicit Processes

Strengths and Weaknesses of Reactive Mechanisms

The IOM/CHCT Process Compared with This IOM Study

Analytic Models

Strengths and Weaknesses of Analytic Models

Need for a Comprehensive, Proactive Process for Priority Setting

APPENDIX: MEDICARE COVERAGE DECISION MAKING

3 Guiding Principles

BUILDING A MODEL PROCESS FOR SETTING PRIORITIES

PROCESS BUILDING FOR OHTA

The Process Must Reflect the Mission of OHTA

Potential to Reduce Pain, Suffering, and Premature Death

Potential to Reduce Inappropriate Health Care Expenditures

Potential to Reduce Inequity and Inform Other Social Issues

The Product of the Process Should Be Consistent with the Needs of Users

The Process Must Be Efficient

The Process Must Be Sensitive to the Environment in Which OHTA Operates

4 Recommendations for a Priority-Setting Process

PREVIEW OF THE QUANTITATIVE MODEL

ELEMENTS OF THE PROPOSED PRIORITY-SETTING PROCESS.

Step 1. Selecting and Weighting Criteria Used to Establish Priorities

Step 2. Identifying Candidate Conditions And Technologies

Step 3. Winnowing the List of Candidate Conditions and Technologies

Step 4. Data Gathering

Step 5. Creating Criterion Scores

Step 6. Computing Priority Scores

Step 7. Review By Ahcpr National Advisory Council

DETAILS OF THE PROPOSED PRIORITY-SETTING PROCESS

Step 1. Selecting And Weighting The Criteria Used To Establish Priority Scores

Selecting Criteria

Weighting Criteria

Step 3. Winnowing The List Of Candidate Conditions And Technologies

Secondary Winnowing Processes

Specifying Alternative Technologies And Clinical Conditions

Staff Summaries Of Clinical Conditions

General Points

Criteria Recommended For The Iom Priority-Setting Model

Criterion 1: Prevalence

Criterion 2: Burden Of Illness

Criterion 3: Cost

Criterion 4: Variation In Rates Of Use

Criterion 5: Potential Of The Results Of An Assessment To Change Health Outcomes

Criterion 6: Potential Of The Results Of An Assessment To Change Costs

Criterion 7: Potential of the Results of an Assessment to Inform Ethical, Legal, and Social Issues

Criteria Rejected by the Committee

Derivation of the Model

Determining Whether Assessment is Desirable and Feasible

Step 7. Review by Ahcpr National Advisory Council

REASSESSMENT

Role of Reassessment in the Complete Assessment Program

Methods of Identifying Candidates for Reassessment

Ongoing Tracking of Events Related to Previously Assessed Topics

Evaluation of the Quality of Studies

Ranking Candidates for Reassessment

Final Steps after Establishing Priority for Reassessment.

Sensitivity Analysis

Cost Analysis

APPENDIX 4.1: WINNOWING PROCESSES

Intensity Rankings by Nominating Persons and Organizations

Preliminary Ranking Processes

Panel-Based Preliminary Weighting

Comment

APPENDIX 4.2: METHODOLOGIC ISSUES

Properties of Logarithms

Application to the Iom Model

5 Implementation Issues

THE PRIORITY-SETTING CYCLE

SETTING CRITERION WEIGHTS

RESOURCES NEEDED TO IMPLEMENT THE PROCESS

Technology Assessment Program Staff Requirements

Priority-Setting Panel

IMPLEMENTATION CONSIDERATIONS FOR OHTA AND OTHER ORGANIZATIONS

Validity and Reliability

Criteria

Choosing-and Changing-Criteria

Criterion Weights

Availability of Data to Generate Criterion Scores

WHEN THE SCIENTIFIC EVIDENCE IS INSUFFICIENT FOR ASSESSMENT

Interim Statements

Modeling

6 Recommendations and Conclusions

REVIEW OF THE COMMITTEE'S RATIONALE AND RECOMMENDATIONS

Recommendations

REVIEW OF STEPS AND ISSUES IN IMPLEMENTATION

Steps in a Priority-Setting Process

Step 1. Selecting and Weighting the Criteria Used to Establish Priority Scores

Step 2. Identifying Candidate Conditions and Technologies

Step 7. Review of Priority Rankings by the National Advisory Council of the Agency for Health Care Policy and Research

Resources for Implementation

Publicly Available Products.

Topics with Insufficient Evidence for Assessment Based on Review of the Literature

Will a Numerical Priority Score Lead to Unrealistic Inferences About Priority?

Does Codifying an Idealized Process Lead to Inflexibility?

Will There Be a Bias Toward Choosing Topics That Are Quantifiable?

CONCLUSION

References

Appendix A Pilot Test of the IOM Model

METHODS

Topics and Data for Priority Setting

Criterion Weighting

Criterion Scoring

Convened Pilot

Objective Criterion Scores.

Mailed Pilot

RESULTS

Feasibility

Improvements in the Model

Comparison of Convened and Mailed Methods

Criterion Scores

Priority Scores

IMPLICATIONS OF THE PILOT TESTS FOR THE IOM MODEL

Appendix B Abbreviations.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references (p. 131-135).

ISBN:

9786610203192

9781280203190

1280203196

9780309575577

0309575575

9780585149097

0585149097

OCLC:

43477127