Douw Karla, Vondeling Hindrik
Department of Health Economics, University of Southern Denmark, Odense C, Denmark.
Int J Technol Assess Health Care. 2006 Spring;22(2):177-83. doi: 10.1017/S0266462306050999.
Uncertainty is pervasive in decision making on new health technologies; therefore, some countries have put systems in place to support decision makers with timely information. An important, but as yet undocumented, determinant of the potential value for decision making of these so-called horizon scanning systems (HSSs) is how the most significant health technologies are selected.
All thirteen member organizations of EuroScan, a collaborative network for HSSs, were surveyed and interviewed on how they prioritize technologies for assessment.
The majority of HSSs directly serves a customer. Some customers actively request early assessments of new health technologies, thereby diminishing the need for priority setting for the HSSs. All systems express a concern to miss an important technology and/or to select an unimportant technology. Almost all HSSs use explicit selection criteria, but these criteria hardly ever are operationalized. The number of criteria used varies, but costs and health benefit of the technology are always taken into account. The process of reaching a final decision is implicit, undocumented in all but one system, and is based on agreement by consensus.
The process of making the final decision on which technologies to assess can be improved by applying existing criteria more consistently and transparently. Current practice does not safeguard against missing an important technology. This finding is probably most important to act upon for systems with customers that do not actively request assessment of specific technologies.
在新型卫生技术的决策过程中,不确定性普遍存在;因此,一些国家已建立相关系统,以便为决策者提供及时信息。这些所谓的前沿扫描系统(HSSs)对决策潜在价值的一个重要但尚未记录的决定因素是如何选择最重要的卫生技术。
对HSSs协作网络EuroScan的所有13个成员组织进行了调查,并就它们如何对技术评估进行优先级排序进行了访谈。
大多数HSSs直接服务于一个客户。一些客户积极要求对新型卫生技术进行早期评估,从而减少了HSSs进行优先级设定的必要性。所有系统都担心错过一项重要技术和/或选择一项不重要的技术。几乎所有HSSs都使用明确的选择标准,但这些标准几乎从未得到实施。所使用的标准数量各不相同,但技术的成本和健康效益总是会被考虑在内。做出最终决定的过程是隐含的,除了一个系统外,在所有系统中都没有记录,并且是基于共识达成的一致意见。
通过更一致、透明地应用现有标准,可以改进对哪些技术进行评估的最终决策过程。目前的做法无法防止错过一项重要技术。对于那些客户不积极要求评估特定技术的系统来说,这一发现可能是最需要采取行动的。