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Technology Assessment Program Offers Guidance as Systems Change Quickly


Carolyn M. Clancy, MD
Director
Agency for Healthcare

There is little doubt that American health care benefits enormously from rapidly advancing clinical and information technology.  New therapies that just a few years ago were considered cutting-edge are now applied routinely, giving millions of patients access to care and treatment options that once would have been out of reach. 

However, rapid technological improvements create challenges as well as opportunities.  It is difficult to keep pace with change when it occurs so swiftly, as systems that relatively recently were deemed state-of-the-art quickly become outdated, even obsolete.  Sometimes, conflicting or confusing evidence—not to mention often-high initial costs—calls the benefit of such advancements into question.  Also, a new innovation may not offer greater value or clinical benefit than a tested older technology. 

As innovations emerge, it is important to evaluate them quickly and dispassionately to ensure that resources are applied both efficiently and judiciously.  This is particularly important because the federal government, through Medicare, is the largest single user of these technologies.  Coverage decisions made by the Centers for Medicare & Medicaid Services (CMS) drive adoption in the health care marketplace and thus must be considered very carefully.

The technology assessment program at the Agency for Healthcare Research and Quality (AHRQ) conducts thorough reviews of new technology for CMS.  These technology assessments are used by CMS to inform its national coverage decisions for the Medicare program and to provide information to Medicare carriers.

A Synthesis of Data

AHRQ’s technology assessment program consists of systematic reviews, horizon scans, which are preliminary looks at emerging interventions, and studies of scientific policy issues.  The systematic review process uses state-of-the-art methodologies for assessing the clinical utility of medical interventions.  Technology assessments are based on a systematic review of the literature, along with appropriate qualitative and quantitative methods of synthesizing data from multiple studies. 

In conducting the technology assessment, reviewers ask:  

• What is the nature of the disease or condition being treated?
• What are the ’conservative,’ or commonly accepted, treatments?
• What are the new advancements in treatment?
• What is the overall net health benefit, taking into account all benefits and harms of the intervention?
  

These academic, rigorous studies are important to gauge whether they are worth Medicare’s considerable time and investment.

Technology assessments are done in-house by AHRQ or in collaboration with one of its Evidence-based Practice Centers—academic-based centers under contract with AHRQ to develop reports and review evidence on its behalf.1   

Reflecting the role that technology has long played in health care, AHRQ’s predecessor, the Agency for Health Care Policy and Research, started conducting technology assessments in 1990.  The endeavor was specifically authorized by Congress when the Agency was reauthorized in 1999, in Section 916 of the Healthcare Research and Quality Act of 1999.2 

These assessments cover a variety of clinical issues.  For example, recently completed reports assessed home diagnosis of obstructive sleep apnea-hypopnea syndrome3 and decompression therapy for the treatment of lumbosacral pain.4  In 2007,  eight technology assessments were completed, with seven completed in 2006.   

As of mid-January 2008, 12 assessments are currently in progress.  These include: 

• Discharge Planning: Effectiveness of Discharge Planning in Patients with Heart Failure
• Evaluating the Cost-Effectiveness of Stool DNA Tests for Colorectal Cancer Screening in the Medicare Population
• Focused Reviews on Selected Gene Tests for Cancer and Noncancer Conditions
• Health and Behavior Assessment/Intervention for the Management of Physical Health Problems—Cancer Pain
• Horizon Scan: Clinical Trials Enrollment and Third Party Payment
• Horizon Scan: Lipoprotein Subfractions for Identifying Patients at Increased Risks for Cardiovascular Diseases
• Peripheral Artery Stenting
• Pulmonary Artery Catheterization
• Quality, Regulation, and Clinical Utility of Laboratory-Developed Tests
• Spinal Fusion for the Treatment of Low Back Pain Secondary to Lumbar Degenerative Disc Disease 
• Targeted Therapies for Cancer
• Use of Bayesian Techniques in Randomized Clinical Trials: A CMS Case Study
  

For more information about the AHRQ technology assessment program, including links to all previously published assessments, visit http://www.ahrq.gov/clinic/techix.htm.