In 2010, CMTP conducted a priority setting process to identify important emerging oncology technologies that lack sufficient evidence to guide clinical decision-making. CMTP used its in-house priority-setting process (see Priority-setting Manual) ensuring that topics were selected in an open and transparent manner, using objective criteria, with multi-stakeholder input. The goal was to identify important topics for use in our Effectiveness Guidance Documents (EGDs).
The process included:
1) Horizon-scanning to identify initial list of topics: A broad initial list of candidate oncology technologies was generated through a review of international and domestic horizon-scanning literature and recent technology assessments, nominations by external stakeholders, and the identification of technologies failing to receive widespread favorable coverage decisions. Sources included the California Technology Assessment Forum (CTAF), the Kaiser Permanente Interregional New Technologies Committee, the Blue Cross Blue Shield Association’s Technology Evaluation Center, AHRQ, CMS, the Canadian Agency for Drugs and Technologies in Health (CADTH), the McGill Technology Assessment Unit, the Australia and New Zealand Horizon Scanning Network (ANZHSN), the Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), and the Centre for Reviews and Dissemination (CRD) at the University of York, among others. Topics were limited to those oncology technologies that were assessed within the previous 18 months.
2) Narrowing topics to list of approximately ten technologies: The horizon-scanning process generated a broad list of about 50 oncology topics spanning different types of cancer and different types of technologies (i.e. diagnostic, imaging, treatments, etc). CMTP staff narrowed this list down to about 20 technologies, eliminating topics based on a number of pre-established criteria. These included: 1) if the topic was redundant or similar to any topics already underway at CMTP or at other organizations; 2) if there was a small population base or clinical impact; or 3) if we felt that it would not be operationally feasible to carry through. Topics that would not be appropriate for EGDs were also eliminated.
The next step in narrowing the list of topics from 20 to 10 was to consult with a number of relevant stakeholders groups for further input. This step was specifically recommended to us by both CMTP’s Advisory Board and the Patient and Consumer Advisory Committee (CMTP). CMTP solicited feedback on the top 20 technologies from payers (including Kaiser, Highmark, and Aetna), patient advocacy organizations (such as the Friends of Cancer Research, the Colorectal Cancer Coalition, and the National Coalition for Cancer Survivorship), medical professional societies (such as the National Comprehensive Cancer Network and the Southwest Oncology Group), as well as other clinicians and researchers. Based on their feedback, a list of 10 technologies, including a topic not identified in the horizon scan, was indentified.
3) Creation of an Expert Working Group: CMTP created a small working group of patient advocates, payers, clinicians, and researchers with expertise in oncology to assist CMTP in prioritizing the top 10 list of topics and identifying the top technologies best suited to a new round of EGDs. A diverse array of perspectives, including experts in radiation, surgical, and medical oncology, was maintained.
4) Conduct background research and write ten “technology briefs: A 5 -10 page technology brief was created for each topic. These briefs included:
- Description of the technologies, approved indications, known information about diffusion
- Description of the patient group, expected utilization rates
- High level summary of the current research evidence of clinical effectiveness, benefits, harms, and any known evidence gaps, patient safety issues
- Details of any ongoing or related research activities,
- provider coverage policies, costs, and cost-effectiveness
5) Conduct initial priority-setting: Web-based survey: CMTP used a modified nominal group technique, with iterative rounds of ranking topics. The completed technology briefs on each of the top 10 technologies were provided to our expert working group to do an initial ranking of the technologies based on our priority-setting criteria.
6) Conduct final round of priority-setting: In-person meeting: The in-person meeting was held on July 12, 2010 in Baltimore, MD. The summary of that meeting can be review in this report: Oncology Technology Selection Workgroup Summary (pdf) (383.83 kB) . Final ranked topics can be found here: CMTP’s Priority Setting in Oncology (pdf) (460.85 kB) .