A. Identify Candidate Topics

To a large extent, assessment topics are determined, or bounded, by the mission or purpose of an organization. For example, national and regional health plans and other third-party payers generally assess technologies on a reactive basis; a new medical or surgical procedure that is not recognized by payers as being standard or established may become a candidate for assessment. For the US Centers for Medicare and Medicaid Services (CMS), some assessment topics arise in the form of requests for national coverage policy determinations that cannot be resolved at the local level or that are recognized to be of national interest. These requests typically originate with Medicare contractors that administer the program in their respective regions, Medicare beneficiaries (people who are eligible for Medicare), physicians, health product companies, health professional associations, or government entities. CMS may request assistance in the form of “evidence reports” or HTAs from a sister agency, AHRQ, which typically commissions these from one of its Evidence-based Practice Centers (part of the AHRQ Effective Healthcare Program).

Apart from requests from CMS, the AHRQ Effective Healthcare Program solicits topic nominations from the public. Its online topic nomination form requests information about: the health care intervention of interest; any specific comparator(s); patient groups and subgroups affected; health benefits or outcomes; risks/harms/side effects; which (if any) of 14 priority health conditions/diseases are involved; which (if any) of six priority populations is involved; which (if any) federal health program (e.g., Medicare, Medicaid) is involved; why the topic is important; whether the question represents uncertainty for clinicians or policymakers; stakeholders in this topic; how the findings will be used; technical experts relevant to the topic; and any supporting documentation.

For the UK National Institute for Health and Care Excellence (NICE), topics are not determined internally, but are referred from the UK Department of Health. Topics are selected based on such factors as burden of disease, impact on resources, and whether there is inappropriate variation in practice across the UK (NICE 2013).

For the Cochrane Collaboration, potential topics generally arise from members of the more than 50 review groups, who are encouraged to investigate topics of interest to them, subject to the agreement of their review groups. However, there is as yet no standard or common priority-setting process used across the Cochrane Collaboration (Nasser 2013).

Horizon Scanning

The demand for early information about new, emerging, and existing health care interventions and related trends has prompted the development and evolution of “horizon scanning” functions (Carlsson 1998; Douw 2003; Harper 1998; Packer 2012). Horizon scanning is intended to serve multiple purposes, including, e.g., the following:

  • Identify potential topics for HTA and information for setting priorities among them
  • Identify areas of technological change
  • Anticipate and identify new indications or uses of technologies
  • Identify variations in use of technologies
  • Identify inappropriate use of technologies, including over-use, under-use, and improper use
  • Forecast the health and economic impacts of technologies
  • Identify levels in improvement in effectiveness in relation to additional costs that would demonstrate the cost-effectiveness of a new technology
  • Anticipate potential social, ethical, or legal implications of technologies
  • Plan data collection to monitor adoption, diffusion, use, and impacts of technologies
  • Enable health care providers, payers, and patients to plan for, adapt to, and manage technological change, including “rising”/emerging technologies and “setting” (becoming obsolescent) technologies (for potential disinvestment)

Most horizon scanning programs generate rapidly completed, brief descriptions of new or emerging technologies and their potential impacts. Certainly, there are tradeoffs inherent in using early information that may be incomplete or unreliable as opposed to waiting long enough for more definitive information that opportunities to benefit from it may have passed. HTA programs have made use of horizon scanning in important ways. While the major thrust of horizon scanning has been to identify “rising” (new and emerging) technologies that eventually may merit assessment, horizon scanning can identify “setting” technologies that may be outmoded, superseded by newer ones, and candidates for disinvestment (Henshall 2012.) In either case, horizon scanning provides an important input into setting assessment priorities.

Examples of national and international horizon scanning programs are:

  • AHRQ Healthcare Horizon Scanning System (US)
  • Canadian Network for Environmental Scanning in Health (CNESH, secretariat at Canadian Agency for Drugs and Technologies in Health [CADTH])
  • Centers for Medicare and Medicaid Services Council for Technology and Innovation (US)
  • ECRI Institute Health Technology Forecast
  • EuroScan International Network (International Information Network on New and Emerging Technologies) (secretariat at NHSC, UK)
  • Health Policy Advisory Committee on Technology (HealthPACT, Australia and New Zealand)
  • National Evidence-based Healthcare Collaborating Agency Horizon Scanning Center for Innovative Global Health Technology (NECA H-SIGHT, South Korea)
  • National Horizon Scanning Centre (NHSC, UK)

For example, the purposes of EuroScan, a collaborative network involving about 20 HTA agencies, are to collect and share information on innovative health care technologies to support decision making and adoption and use of effective, useful, and safe technologies, as well as to provide a forum for sharing and developing methods for early identification and assessment of new and emerging technologies and predicting their potential impacts.

The Canadian Network for Environmental Scanning in Health (CNESH) identifies information on new, emerging, or new applications of health technologies and shares this information across Canada. It also develops and promotes methods for identifying, filtering, and setting priorities among new or emerging health technologies. CNESH produces a “top 10” list of new and emerging health technologies in Canada.

The Health Policy Advisory Committee on Technology (HealthPACT) provides evidence-based advice about potentially significant new and emerging technologies to health departments in Australia and New Zealand. This supports information exchange and evaluation of the potential impact of these technologies on those national health systems, including informing financing decisions and the managed introduction of new technologies. HealthPACT produces New and Emerging Health Technology Reports and Technology Briefs.

The AHRQ Healthcare Horizon Scanning System provides AHRQ with a systematic process to identify and monitor target technologies and create an inventory of those that have the highest potential for impact on clinical care, the health care system, patient outcomes, and costs. This system is also intended to serve as a tool for the public to identify and find information on new health care technologies (ECRI Institute 2013).

EUnetHTA developed a web-based Planned and Ongoing Projects (POP) database to enable HTA agencies to share information about planned and ongoing projects at each agency, with the aim of avoiding duplication and encouraging collaborative efforts (EUnetHTA 2013).

A 2013 systematic review of international health technology horizon scanning activity identified 23 formal programs, most of which are members of EuroScan, along with a variety of other less structured horizon scanning functions of government and private sector organizations. Although the formal programs had somewhat varying emphases on target technologies, time horizons of interest, and methods of scanning and assessment, they generally shared the main functions of identification and monitoring of technologies of interest and evaluation of potential impacts of technologies (Sun 2013).

As shown in Box VI-1, a considerable variety of electronic bibliographic databases, newsletters, regulatory documents, and other sources provide streams of information pertaining to new and emerging health care interventions. The AHRQ Horizon Scanning Protocol and Operations Manual provides a detailed list of databases, news sources, and other information sources for horizon scanning, as well as search filters for horizon scanning of PubMed and Embase (ECRI Institute 2013).

Box VI-1. Information Sources for New and Emerging Health Care Interventions

  • Large bibliographic databases (e.g., PubMed, Embase, SciSearch)
  • Specialized bibliographic databases (e.g., CINAHL, PEDro, PsycINFO)
  • Databases of ongoing research and results (e.g., ClinicalTrials.gov, HSRProj)
  • Priority lists and forthcoming assessments from HTA agencies and vendors
  • Cochrane Collaboration protocols (plans for forthcoming/ongoing systematic reviews)
  • Trade publications (e.g., The Pink Sheet, The Gray Sheet, In Vivo, Medtech Insight, Pharmaceutical Approvals Monthly, Medical Device Daily, GenomeWeb Daily News, Telemedicine and e-Health)
  • General news (e.g., PR Newswire, New York Times, Wall Street Journal)
  • General health care/medical journals and specialty health care/medical journals
  • Health professions and industry news (e.g., American Health Line, Medscape, Reuters Health Industry Briefing, , Reuters Health Medical News)
  • Conference abstracts and proceedings of health professions organizations, health industry groups
  • Technology company web sites
  • Industry association (e.g., AdvaMed, BIO, PhRMA) sites (e.g., AdvaMed SmartBrief, PhRMA New Medicines Database)
  • Market research reports (e.g., Frost & Sullivan; GlobalData; IHS Global Insight; Thomson Reuters)
  • Regulatory agency announcements of market approvals, other developments for new pharmaceuticals, biological, and devices (e.g., FDA Advisory Committee Alerts, FDA Approval Alerts, FDA Drug Daily Bulletin, FDA Device Daily Bulletin)
  • Adverse event/alert announcements (e.g., from FDA MedWatch, NIH Clinical Alerts and Advisories, United States Pharmacopeia)
  • Payer policies, notifications (e.g., CMS Updates to Coverage Pages, Aetna Clinical Policy Bulletins)
  • Reports and other sources of information on significant variations in practice, utilization, or payment policies (e.g., The Dartmouth Atlas)
  • Special reports on health care trends and futures (e.g., from Institute for the Future Health Horizons Program; Institute for Healthcare Improvement)

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