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 -- Reassessment -- 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 -- SUMMARY -- 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 -- SUMMARY -- 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 2. Identifying Candidate Conditions And Technologies -- Step 3. Winnowing The List Of Candidate Conditions And Technologies -- Secondary Winnowing Processes -- Step 4. Data Gathering -- Specifying Alternative Technologies And Clinical Conditions -- Staff Summaries Of Clinical Conditions -- Step 5. Creating Criterion Scores -- 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 -- Step 6. Computing Priority Scores -- 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 -- SUMMARY -- 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 -- Publicly Available Products -- WHEN THE SCIENTIFIC EVIDENCE IS INSUFFICIENT FOR ASSESSMENT -- Interim Statements -- Modeling -- SUMMARY -- 6 Recommendations and Conclusions -- REVIEW OF THE COMMITTEE'S RATIONALE AND RECOMMENDATIONS -- Recommendations -- Recommendation 1 -- Recommendation 2 -- Recommendation 3 -- Recommendation 4 -- Recommendation 5 -- Recommendation 6 -- Recommendation 7 -- Recommendation 8 -- Recommendation 9 -- Recommendation 10 -- Recommendation 11 -- 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 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 of Priority Rankings by the National Advisory Council of the Agency for Health Care Policy and Research -- Resources for Implementation -- The Priority-Setting Cycle -- Publicly Available Products.

Topics with Insufficient Evidence for Assessment Based on Review of the Literature -- ADOPTION OF THE IOM'S PRIORITY-SETTING PROCESS BY OTHER ORGANIZATIONS -- Technology Assessment and Clinical Practice Guidelines -- POTENTIAL PROBLEMS WITH THE PRIORITY-SETTING PROCESS -- 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 -- Criteria -- Criterion Weighting -- Criterion Scoring -- Convened Pilot -- Objective Criterion Scores. -- Mailed Pilot -- RESULTS -- Feasibility -- Improvements in the Model -- Comparison of Convened and Mailed Methods -- Criterion Weights -- Criterion Scores -- Priority Scores -- IMPLICATIONS OF THE PILOT TESTS FOR THE IOM MODEL -- Criterion Scores -- Appendix B Abbreviations.