"Health technology assessment is a race against health technology diffusion."

Prof. Frachet
President of CEDIT

History and structure
The CEDIT (Committee for the Evaluation and Diffusion of Innovative Technologies) was created by Assistance Publique-Hôpitaux de Paris (AP-HP, regional university hospital group for Paris area, 39 hospitals) in 1982.

The CEDIT is a multi-disciplinary committee including physicians from different specialties, hospital managers and the headquarters' division directors. It is assisted by a permanent scientific secretariat composed of project leaders (physicians, pharmacists, and scientists), hospital manager, economist, biomedical scientist and methodologist.

Mission
The CEDIT is responsible for formulating opinions for the general manager of AP-HP on opportunities for the dissemination of technological innovations and the extent and mode of dissemination desired in the AP-HP hospitals. The mission is threefold:

• Assessment of new technologies in terms of technical, clinical, economic, organizational, legal and ethical aspects
• Aid in technology implementation and use
• Identification of potentially valuable emergent technologies.

The CEDIT scientific secretariat is part of the Medical Activities Department whose mission is to carry out prospective analysis and to propose strategies aimed at adapting healthcare delivery within AP-HP to expected evolutions (in terms of healthcare needs, medical progress, organization and quality of healthcare at the local, regional and national level).

The CEDIT scientific secretariat is also involved in another program aimed at optimizing the prescription of the most costly and innovative drugs and individual-use devices (about 120 molecules and 80 classes of devices) and of biology and imaging tests. Its mission is to establish good practice guidelines using scientific evidence and expert groups.

How CEDIT works
The CEDIT acts upon request from physicians or directors of the AP-HP. Its scientific secretariat prepares a report for the committee for each technology submitted.

To produce the report, scientific secretariat members conduct an extensive search and analysis of the literature on technical, clinical, economic, organizational, legal and ethical aspects, and hold meetings and consultations with experts in the field. If the information is insufficient for the committee to make a recommendation on diffusion, it recommends the carrying out of evaluation trials and may specify the methodological, logistic and financial aid that it would like to contribute to the technology implementation.

Dissemination activities
The scientific secretariat of the CEDIT is responsible for dissemination of the works of the committee. The recommendations of the CEDIT are systematically sent to the general management of AP-HP, to the management of AP-HP hospitals, to the biomedical engineers and to the physicians of the specialties concerned. The technology evaluation reports are sent systematically to the expert of each dossier. CEDIT activity reports are disseminated in the same way within AP-HP but also sent to CEDIT experts and to several external bodies (ministerial structures, hospitals in Ile-de-France and university hospitals in the provinces, health insurance, regional health authorities.). CEDIT recommendations are available on line (in French and English) on the website and full reports (in French) can be ordered free of charge.

Current projects (a selection)

• Ongoing systematic reviews:
  - Cone-beam computed tomography for odontostomatology
  - Low-dose 2D/3D X-ray scanning (EOS® system)
  - Dedicated and low-field MRI
  - Digital mammography (update)
• Ongoing trials:
  - MARS liver support (Molecular Adsorbents Recirculating System)
  - Comparison between radiofrequency and cryosurgery for liver metastasis
  - Mandibular advancement ortheses
• Ongoing implementation:
  - Cyclotron for PET radiopharmaceuticals production and research 
  - Nutrition support teams Autologous fibrin sealants (Vivostat ® system)
  - Reference centers for obesity

Future plans

• To continue with systematic, evidence based reviews in key areas concerning health care.
• To develop better methodologies to assess health technologies (eg scoring of level of evidence and strength of recommendations) and identify new and emerging health technologies of importance to the health system.
• To continue developing good practice guidelines for the prescription of the most costly and innovative drugs and individual-use devices and of biology and imaging tests.