Identification, Prioritization, and Assessment of Obsolete Health Technologies. A Methodological Guide

Aim: To propose a methodology to identify, prioritize, and assess obsolete health technologies.

Conclusions and results: To assess any obsolete health technology, a standardized process that enables identification, prioritization, and assessment must be established. It is essential to determine the impact to be expected a priori from defining any given technology as obsolete, since the greater the impact, the more the health system will benefit from its assessment and subsequent exclusion.

Identification: five potential detection sources, classified as active or proactive, were established. Active sources include: 1) direct consultation of medical literature; 2) consultation of new and emerging technology databases; 3) consultation of systematic reviews; and 4) consultation with secretariats tasked with updating National Health System, hospital, or regional service portfolios. Proactively, networks of health professionals would submit reports on potentially obsolete technologies to HTA agencies or units. After identification of potentially obsolete technologies, assessment agencies would use a standardized procedure to confirm that the technology could be classified as potentially obsolete. It could then be prioritized, or assessed if it had already been prioritized.

Prioritization: to prioritize potentially obsolete technologies for assessment, a prioritization tool (PriTec tool) and a Web application were created. The tool has three domains (population/end-users; risk/benefit; and costs, organization, and other implications) and 10 criteria. The domains are weighted on the scale. Clinicians, managers, and end-users participated in the weighting and in selecting the criteria. Using these results, a Web application in Spanish and English was made available free of charge (via the avalia-t website). It enables up to 50 potentially obsolete health technologies to be compared and prioritized for assessment purposes.

Assessment: to assess a potentially obsolete technology, an assessment-document structure was proposed to compare benefits (efficacy, safety, efficiency, cost, etc) of the potentially obsolete versus the proposed alternative technology. The technology assessment section is based on a systematic review and should meet the requirements of being straightforward, methodical, and reproducible.

Methods: We searched for scientific literature up to April 2009 in specialized databases, eg, HTA, DARE, NHS EED, and Cochrane Plus Library; and in general databases, eg, MEDLINE, EMBASE, IME (Índice Médico Español-Spanish Medical Index), and IBECS (Índice Bibliográfico en Ciencias de la Salud).

We also reviewed several databases and Internet search engines with special emphasis on the websites of national HTA agencies and government bodies, particularly in the area of health services research. We selected records in which any type of obsolete technology was assessed or which contained opinions, ideas, advantages, or limitations concerning any aspect linked to obsolete health technologies. Since we used no inclusion or exclusion criteria, records were selected on the consensus of two authors. In addition to the systematic review, a specific methodology was developed for each of the 3 sections of the guide.

Further research/reviews required: None.

Written by: Alberto Ruano-Ravina, AVALIA-T, Spain