CNESH: Top 10 ProcessANDRA MORRISON14 APRIL, 2015

2

CNESH Processh

50 Nominated

48 Filtered

45 Verified

Prioritized

Top 10 Disseminated

Evaluation

2 excluded = 48

28 excluded = 17

7 excluded = 10

3 excluded = 45

Stage 1

Stage 2

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.

Nomination

Filtration

Verification

Prioritization

Dissemination

Evaluation

4

Filtration

Criteria

Is the technology new and/or emerging?

Are compulsory questions appropriately addressed?

Nomination

Filtration

Verification

Prioritization

Dissemination

Evaluation

New

5

CNESH Definition of Health TechnologyIncludes:• 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

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CNESH Definition of New & Emerging

“New” Health TechnologyA 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 TechnologyA 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.

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Verification

• Submitted references reviewed and

literature search conducted

• Nomination form reviewed

• Nomination form key criteria verified

• Key criteria rated

Nomination

Filtration

Verification

Prioritization

Dissemination

Evaluation

8

Criteria for Assessing Technologies

Criteria Scale used ScoreSize of population >1,000,000

500,000-999,000100,000-499,99950,000-99,999<50,000

+2+10-1-2

Survival (mortality)SafetyEffectivenessQOL

Significant improvementMinor/moderate improvementNo differenceMinor/moderate worseSignificantly worse

+2+10-1-2

Upfront costOn-going costImplementation needs

Significantly lessMinor/moderate lessNo differenceMinor/moderate moreSignificantly more

+2+10-1-2

Prioritization: Stage 1

In

Out

Maybe

Nomination

Filtration

Verification

Prioritization

Dissemination

Evaluation

10

Prioritization: Stage 2

Clinical experts: specialists and general practitioners +CNESH Prioritization Committee

Review summaries and key articles on nominated technologies

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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?

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Prioritization: Stage 2

General practitioners meet with CPC and discuss each technology.

Final decision is made by CPC

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Dissemination

• Launch at CADTH symposium

• CNESH website

• Social/print media

Nomination

Filtration

Verification

Prioritization

Dissemination

Evaluation

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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

Nomination

Filtration

Verification

Prioritization

Dissemination

Evaluation

15

Questions?