CNESH: Top 10
Process
ANDRA MORRISON
14 APRIL, 2015
CNESH Process
h
50 Nominated
2 excluded = 48
48 Filtered
3 excluded = 45
45 Verified
28 excluded = 17
Prioritized
Top 10
Disseminated
Evaluation
1
7 excluded = 10
Nomination
Nomination
Filtration
Verification
Prioritization
Dissemination
Evaluation
2
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.
Filtration
New
Nomination
Filtration
Criteria
Is the technology new and/or emerging?
Verification
Prioritization
Dissemination
Evaluation
3
Are compulsory questions appropriately
addressed?
CNESH Definition of Health
Technology
Includes:
• Drugs - biologics, blood products, vaccines and prescription and nonprescription 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
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
Verification
Nomination
• Submitted references reviewed and
literature search conducted
Filtration
Verification
Prioritization
• Nomination form reviewed
• Nomination form key criteria verified
Dissemination
• Key criteria rated
Evaluation
6
Criteria for Assessing Technologies
Criteria
Scale used
Score
Size of population
>1,000,000
500,000-999,000
100,000-499,999
50,000-99,999
<50,000
Significant improvement
Minor/moderate improvement
No difference
Minor/moderate worse
Significantly worse
Significantly less
Minor/moderate less
No difference
Minor/moderate more
Significantly more
+2
+1
0
-1
-2
+2
+1
0
-1
-2
+2
+1
0
-1
-2
Survival (mortality)
Safety
Effectiveness
QOL
Upfront cost
On-going cost
Implementation needs
7
Prioritization: Stage 1
Nomination
In
Filtration
Verification
Out
Prioritization
Dissemination
Maybe
Evaluation
Prioritization: Stage 2
Clinical experts:
specialists and
general
practitioners
+
CNESH Prioritization
Committee
9
Review summaries and key articles on
nominated technologies
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
Prioritization: Stage 2
General practitioners meet with CPC and discuss each
technology.
Final decision is made by CPC
11
Dissemination
Nomination
Filtration
Verification
• Launch at CADTH
symposium
• CNESH website
Prioritization
• Social/print media
Dissemination
Evaluation
12
Evaluation
Nomination
Filtration
Entire process is evaluated annually – we seek
feedback from everyone involved in the process:
nominators, experts, verifiers, CNESH members
Verification
Prioritization
Dissemination
Evaluation
13
Lessons learnt:
• Don’t announce the call for nominations during
the summer holidays
• Nominators exaggerate claims
• Media and their readers love Top 10 lists
Questions?
14