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Priority Setting for Comparative Effectiveness Research

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Leonard Davis Institute of Health Economics
Leonard Davis Institute of Health Economics

Author: Seema Sonnad

Gesundheit & Medizin
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Priority-setting for comparative effectiveness research. Seidenfeld JD 1 , Montgomery RW 1 , Sonnad SS 1,2 1 Center for Medical Technology Policy, Baltimore, MD, USA, 2 Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Research Objectives Coincident with the increasing focus on comparative effectiveness research (CER) in the health research community, a number of organizations have begun to engage in prioritizing topics for CER. This poster presents the priority-setting process developed by the Center for Medical Technology Policy (CMTP) and its application to the selection of cardiac technologies. Methods (con’t) After internally refining a broad list of emerging cardiac technologies to a top ten list, we convened an expert workgroup charged with ranking these top technologies using prospectively developed criteria. Experts were provided with a list of criteria and briefs summarizing clinical, economic and ethical aspects of each technology, and then asked to evaluate each topic using a survey tool. After initial ranking, workgroup members met in person to discuss results, any remaining questions, and come to consensus on a prioritized list of final recommendations. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Horizon Scanning Topic Nomination Expert solicitation Topic selection Criteria application Discussion After reviewing background information provided by CMTP, the workgroup completed a web-based survey tool to assess each technology based upon CMTP's priority setting criteria. The workgroup met in-person for a final round of topic prioritization to discuss the background information, ask questions of CMTP staff, and bring in outside information and personal knowledge. Final Ranking ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],At the end of the meeting, participants were asked to produce lists of their preferred topics for various CMTP projects. Follow up conference call to present final rankings, gauge the degree of group consensus, and address lingering concerns and questions CMTP’s criteria for priority-setting For All Projects Coverage with Evidence Development (CED) Clinical impact Timeliness/ Potential for unregulated diffusion Economic impact Value of information Disease burden/patient population Multiple comparators Insufficient or conflicting clinical evidence Non-life threatening disease condition Improvability of evidence High pressure on payers for coverage FDA approved technologies exist Secondary considerations Guidelines for the design of new CER studies High risk of waiting No consensus on research methodology Political/operational feasibility Long-term active clinical development CMTP’s Top 10 Cardiac Technologies 1. Catheter-based ablation for the treatment of atrial fibrillation 2. Pharmacogenetic testing for estimating initial warfarin doses 3. Percutaneous aortic valve replacement (AVR) 4. Percutaneous mitral valve replacement (MVR) 5. Ultrasound for abdominal aortic aneurysm (AAA) 6. Biodegradable coronary stents 7. Autologous stem cell transplantation for acute myocardial infarction 8. DNA-based tests for risk of myocardial infarction 9. Total artificial heart 10. C-reactive protein tests

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