Priority Setting
The primary goal of CMTP is to improve the process for generating high-quality and useful information about the risks, benefits, and costs of promising new medical technologies. Because the pace of innovation in medicine is so rapid and the numbers of technologies that need evaluation far outweigh CMTP’s available resources, we have developed an in-house priority-setting framework to identify and select the most promising medical technologies for consideration. To that end, it is essential that the priority-setting process incorporate the opinions and expertise of all relevant stakeholders. Our topic selection process uses a defined set of criteria (see next page) and a voting process among small working groups comprised of payers, patients, and clinical experts to select priorities within a specific disease area. Selected technology topics are then used in the various products and services that CMTP provides, such as Effectiveness Guidance Documents (EGDs), Coverage with Evidence Development (CED) initiatives, and other coordinated research projects.
Priority Setting Process
First, CMTP engages in horizon scanning for potential topics. This step includes nominations by external stakeholders, and the identification of technologies failing to receive widespread favorable coverage decisions. Technologies are evaluated against a set of criteria generated by CMTP staff and consultants, which includes considerations of the potential clinical benefit (both net benefit and to individual patients), the state of current clinical evidence, cost-effectiveness, potential for unregulated diffusion, demand for the technology within the health care community, and feasibility of study design. For a more comprehensive list of general and project-specific criteria, please review our priority-setting manual. Based on these criteria, CMTP staff narrow down the large initial list of technologies to a list of ten, and provide thorough background information on each of these to a workgroup of technology experts within the disease category representing a range of decision-maker perspectives. The workgroup is asked to review each of the ten technologies against a pre-determined set of criteria, and then holds an in-person meeting to discuss each technology, offer expert opinion, and address questions and concerns. At the end of the meeting, workgroup members are asked to select technologies most promising for CED, and a follow-up conference call is held to present results, address remaining questions, and gauge the degree of group consensus.
Based upon the above mentioned criteria, cardiology and oncology were chosen as the two disease categories for initial focus. Both of these disease areas affect a large number of patients, have significant costs, and challenge payers in their coverage decisions. In no particular order, cardiology was chosen for the first round of prioritization in summer 2009 and oncology for the second round later in the year.
