The article reviewed here is a Department of Health document titled ‘Topic Selection Process for Technology Appraisals. A Consultation Document’ and freely available here. The interesting question to ask before reading this document is how would an organisation efficiently choose health technologies to review – what process would they use for this? One approach to answering this can be found in the current document.
The document begins with many notable objectives. The objectives address the technology selection process and these include transparency and providing professionals and the public with the opportunity to contribute. Cutting the time for selection down to 3 months is of the goal with a simple outcome measure.
Following on from this is some background to this consultation. The document follows on from ‘High Quality Care For All’ (freely available here) in which references are made to the technology appraisal process. The current process is described in part 3 which illustrates this with a flow diagram. There are many steps in the process and health ministers are involved at the later stages. In the diagram it is noted that the minimum time for drug licensing is 9-12 months for instance. After this is a summary of each stage of the process. For instance there is a National Horizon Scanning Centre at the University of Birmingham which plays role of ‘horizon scanning’ for ‘pharmaceutical and biopharmaceutical products’. We learn about NICE’s ‘topic selection team’. A number of different panels convene to discuss the technologies and these are rated. The ratings are then used in the selection process. Various roles are also expanded upon in this section.
The revised process is then described in part 4 which identifies 5 decision points in the process and highlights those which are new. These changes are further discussed in subsequent sections. New criteria were selected when filtering technologies as well as at other stages. Another change occurs with the topic selection consideration panels who no longer use a 5 point scoring system but instead consider the scores from the NICE topic selection team. The third decision point involves some steps being removed and the decision for forwarding technologies to the next stage being retained within NICE. Decision point 4 involves a meeting between ministers and the NICE team and the final decision point is the ministerial referral.
In section 5, the selection criteria are discussed and as well as the evidence base, the role of ‘professional judgement and experience’ is emphasised. Under the criteria there are a number of factors for consideration which were either not included previously or have since been modified and these include ‘burden of disease’, ‘potential for therapeutic benefit’, ‘patient population’ for small populations, resource impact, ‘variation in practice’, ‘timeliness and urgency’ and ‘policy importance’. There follows a section on key questions for the consultation process and instructions on responding to the document. Finally there are two appendices one for the existing selection criteria, another for the proposed new criteria and one containing summary details of the consultation process itself.
This is a consultation document which encourages contributions from those with an interest in this area and gives insights into some of the complex processes that take place in the appraisal of new technologies.
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