Cadth 2015 a7 cneshprocess andra
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This document outlines the 10-step process used by the Canadian Network for Environmental Scanning in Health (CNESH) to identify the top emerging health technologies each year. The process begins with a call for nominations, receiving around 50 nominations. These are then filtered down to 45 through verification of key criteria. The remaining technologies are prioritized through expert evaluation and discussion, with the top 10 disseminated and the entire process evaluated annually for improvements.
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Cadth 2015 a7 cneshprocess andra
- 1. CNESH: Top 10 Process ANDRA MORRISON 14 APRIL, 2015
- 2. CNESH Process h 1 50 Nominated 48 Filtered 45 Verified Prioritized Top 10 Disseminated Evaluation 2 excluded = 48 28 excluded = 17 7 excluded = 10 3 excluded = 45
- 3. Nomination Promote call for nominations: Print and social media, CNESH website, RX&D, MEDEC, HTX, CADTH committees, International HS programs, CNESH, word of mouth. Received nominations: 55% industry, 30% professional orgs and networks, 15% clinicians. 2 Nomination Filtration Verification Prioritization Dissemination Evaluation
- 4. Filtration Criteria Is the technology new and/or emerging? Are compulsory questions appropriately addressed? 3 Nomination Filtration Verification Prioritization Dissemination Evaluation New
- 5. CNESH Definition of Health Technology Includes: • Drugs - biologics, blood products, vaccines and prescription and non- prescription medicines • Medical, dental and surgical devices and procedures • Diagnostics - lab tests, screening programs and diagnostic imaging Does not include: • Health human resources • Health system design • Electronic health-related technologies 4
- 6. CNESH Definition of New & Emerging “New” Health Technology A technology that has been approved for clinical use for only a short time. Medical devices may already be marketed, but are less than 10% diffusion or localized to a few centers. Drugs are considered if they have not received Health Canada approval at the prioritization phase of the CNESH Top 10 cycle. Emerging” Health Technology A technology that has not yet been approved by Health Canada. Drugs are usually in Ph II or III of clinical trials, medical devices will be within 6 – 9 months of marketing. Emerging technologies may also include an existing health technology that is being investigated for a new indication. 5
- 7. Verification • Submitted references reviewed and literature search conducted • Nomination form reviewed • Nomination form key criteria verified • Key criteria rated 6 Nomination Filtration Verification Prioritization Dissemination Evaluation
- 8. Criteria for Assessing Technologies 7 Criteria Scale used Score Size of population >1,000,000 500,000-999,000 100,000-499,999 50,000-99,999 <50,000 +2 +1 0 -1 -2 Survival (mortality) Safety Effectiveness QOL Significant improvement Minor/moderate improvement No difference Minor/moderate worse Significantly worse +2 +1 0 -1 -2 Upfront cost On-going cost Implementation needs Significantly less Minor/moderate less No difference Minor/moderate more Significantly more +2 +1 0 -1 -2
- 10. Prioritization: Stage 2 9 Clinical experts: specialists and general practitioners + CNESH Prioritization Committee Review summaries and key articles on nominated technologies
- 11. Prioritization: Stage 2 Clinical Expert Questions Are you familiar with the technology? Do you consider it to be a potential ‘game changer”? Is the technology already accepted and widely diffused? Does the technology represent a incremental or modest improvement to the SOC? Does it address an unmet need? Does the technology have the potential to have a considerable impact on health outcomes? Will this technology have an impact on the health care delivery infrastructure? 10
- 12. Prioritization: Stage 2 General practitioners meet with CPC and discuss each technology. Final decision is made by CPC 11
- 13. Dissemination • Launch at CADTH symposium • CNESH website • Social/print media 12 Nomination Filtration Verification Prioritization Dissemination Evaluation
- 14. Evaluation Entire process is evaluated annually – we seek feedback from everyone involved in the process: nominators, experts, verifiers, CNESH members Lessons learnt: • Don’t announce the call for nominations during the summer holidays • Nominators exaggerate claims • Media and their readers love Top 10 lists 13 Nomination Filtration Verification Prioritization Dissemination Evaluation
- 15. Questions? 14
Editor's Notes
- Hi, I am giving you a brief overview of our evidence informed process. Please know that the actual process is published on the cnesh website and these slides will be available shortly.
- Here is a simplified version of the process – but I will discuss each stage on independent slides. Overall, we received 50 nominations….
- The Top 10 process kicks off with a call for nominations. We announced this in Sept and it stayed open for approx 6-8 weeks.
- We introduced the filtration phase this year b/c it is consistent with existing HS methodology and helps CNESH to eliminate nominations that do not fit with its definition of a new and emerging health technology.
- So, what is cnesh’s definition of a health technology…
- And, what do we mean by new and emerging……What’s important to remember here is that our definition only includes drugs not already approved by HC at the time of prioritization and devices that may have been approved, but are minimally diffused.
- Verification is conducted by an external organization with extensive experience in conducting evidence-based reviews. First, an IS reviews the references provided by the nominator and then conducts a lit search to identify studies that may have been missed. Once all the evidence is collected, a researcher reviews the technology based on CNESH’s key criteria. Often, the rating given by the researcher is different to that given by the nominator.
- Each CNESH member independently reviews the assessment for each nominated technology and reaches consensus about which ones are in, out and maybes…only those that are categorized as in and maybe make it through
- We move our focus away from evidence and ask clinicians on how technologies may impact clinical care.
- We then invite the general practitioners to have a frank discussion with CNESH about each technology. After these discussions, CNESH decides which ones will make the Top 10 List.