Original Title: Priorización de los temas a evaluar

Authors' objectives: The rapid development of scientific and technical advances in the field of medicine is making available to the health system a large number of preventive, diagnostic, therapeutic and rehabilitative technologies, the effectiveness of which is not always known and the implementation of which forms an important part of health sector costs. Decisions relative to these areas must be based on current and scientific information, making use of explicit criteria because, done in another way, they would be based on incomparable implicit criteria with greater probability of bias and, therefore, difficult to justify. At a time when resources become more and more limited and the needs of the public can arise on limitless occasions, the establishment of our own health policy for our autonomous community is made more and more necessary in order to achieve the best results at all times with the available resurces and with effective cost control. The Basque Autonomous Community (BAC) has complete autonomy in health issues to create and incorporate services that it considers appropriate in the sphere of the Basque country. The authorisation of the Health department regarding procedures and technologies and their implementation in the public and private network of our community, must be scientifically and technically based. It is necessary, therefore, to take decisions based on priorities, as much in the development as in the adoption and diffusion of health technologies which are subjected to evaluation and which guide the identification of medical research and health service needs. Health Technology Assessment (HTA) determines the benefits and costs of a technology by comparing different alternatives. It also studies variations in its utilisation and appropriate use, including studies on social and ethical consequences of its application and the factors that speed up or impede its diffusion. HTA, being directed towards decision-making, should be based on science and scientific methods. Given the number of aspects to be considered, HTA is an interdisciplinary field. Its activities incorporate professionals from medicine, social public representatives take part more and more often. One problem of HTA is the selection of topics to be evaluated or the projects to be developed, mainly when the resources for evaluation are limited and the quantity and scope of the topics to be dealt with is very large. Because of this it is necessary to develop an explicit, participatory and reproducible prioritisation process which allows identification of the most interesting areas. If the prioritisation is not developed explicitly, the selection would be made in an implicit way which would add to the influence of intuition, chance and bias. The prioritisation process attempts to structure thought, to identify the relative importance of the different factors under consideration and to estimate the potential impact of an evaluation. Because of this, one of the main tasks is to define which criteria are of use in valuing health technologies or the clinical conditions to which they are applied.

Authors' results and conclusions: After the valuation of the criteria for each selected topic, the score was calculated, which resulted in the following list, classified, in order of score. Topics(Scoring) 1. Health care of the terminally-ill21.83 2. Use of antibiotics in primary care20.30 3. Periodic control of the chronically-ill. Protocol evaluation. 19.80 4. In-patient and out-patient protocol for AIDS patients16.99 5. Out-patient surgery16.12 6. Menopausal care15,87 7. Laboratory and radiology tests in emergency services15,70 8. Home treatment14.84 9. Analysis of routines in primary health care examinations 14.49 10. Preanaesthesia Information12.55 11. Nuclear magnetic resonance. Protocol of use10.59 12. Training for personnel of health services.9.89

Authors' recommendations: The prioritisation process carried out by Osteba involved the contextualisation of a method developed in the USA, a very different medium to our own, with this being one of the first, experiences of implementation at a European level, as can be seen in the bibliography. The unfavourable aspects of the process were related to the insufficient definition of the proposed topics and the lack of data to express criteria such as prevalence, cost and variation in the rates of use in a quantitative and homogeneous way. The most positive aspect was working with an explicit, reproductible and transparent process. The project improved the service methodology itself and made it more systematic and it also may contribute to the introduction of working methods in which the recommendations are based on the maximum available evidence and on consensus. The practical implementation of this prioritisation process allowed us to identify gaps and deficits which made us reflect on which model to use in the future. In this report a model of "proposal of information/evaluation" is proposed with the intention of providing, in the future, a precise definition of the topics, to express in the most precise definition of the topics, to express in the most precise detail possible the reasons as well as the data and the necessary and available information sources. Given that the proposals come not only from formal but also from informal processes, these requested when needed, this application form can be a valid instrument to receive and limit the evaluation proposals or information. One of the most relevant aspects of this process was the wide participation of professionals and the use of explicit criteria in the reflection process which, we believe, can contribute to an increase in the collective evaluation awareness in the health field. At the same tiem, it is hoped tha it is a valis an enriching contribution to the identification and synthesis process of the prioritisation models, as set out by EURASSESS.

Authors' methods: Of the results taken from the selected bibliography, Osteba valued positively the clarity and the simplicity of the presentation of the prrocess proposed by the Institute of Medicine (IOM) described in 1992 by Donalson and Sox. The IOM process is explicit, with well-differentiated stages and with a reasonable mathematical model. Because of this, it was decided to apply this method to our own context. The IOM method consists of seven stages and takes into account seven weighted criteria. Some of which are quantitative (prevalence, costs, variation in the rates of use) while others are qualitative (burden of the disease and influence of the results of the evaluation on different aspects). It is based on consensus and on synthesis of information for the formulation of objective and subjective criteria as well as for scoring. In the cases in which it is not pissible to have comparable objective data for all the technologies it is proposed that subjective scales are used. The final classification, in order of priority, is obtained by means of a mathematical model. The prioritisation process was supervised by the Health Technology Assessment Office that coordinated the weighting, identification, selection and prioritisation stages, motivating the panels of experts and preparing the necessary material for thhe meetings and for the development of tthe consensus methods used. The weighting of the seven citeria that are subsequently to be used in the mathematical equation applied to each technology, was effecteed by a multidisciplinary panel using consensus techniques (nominal group). The most important criteria was the variation in the rates of use and the least valued was the cost criteria. A large number of health proffesionals, who were relied upon to identify the necessary topics to be evaluated put forward more than 120 proposals. This allowed the identification of a wide range of topics related to different levels of health care: primary care, diverse medical specialities, management and health pplanning. Finally, given the similarity between some of the proposals, the definitive list to which the formal process was applied contained 104 proposals which came from preventive, diagnostic and therapeutic areas of medicineand dealt with procedures already in use and also new technologies. The Delphi method wwith two consultations was used to obtain a reduced list of topics. 67 preffesionals from diverse areas and specialities took part. A system of "in and out" was applied in which a percentage of the technologies with the highest score went onto the list of prioritisation. The final 50% were set aside and voting on the intermediate group was repeated. In this wway, a lis of 12 technologies was obtained which were thw subject of the final part of the process. After this, an active search of relevant information necessary to value each of the criteria applied to the technologie was undertaken. A dossier for each member of the scoring panel was compiled and theey went on to the following scoring stage. On this occasion it appeared to be advantageous not to be as extensive as in the IOM model. So, a multidisciplinary panel of 10 experts was convoked with operational aims. Those who took part were professionals from primarry care, internal medicine, cardiology, quality management, etthics, health management, economics, education, nursing, epiidemiology and, although the finally did not attend, consumers' representatives were also invited.

Project Status: Completed

Year Published: 1996

URL for published report: https://www.euskadi.eus/contenidos/informacion/1996_osteba_publicacion/es_def/adjuntos/1996/d_96_01_e_prioritisation_evaluation.pdf

URL for additional information: https://www.euskadi.eus/contenidos/informacion/1996_osteba_publicacion/es_def/adjuntos/1996/d_96_01_priorizacion.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>