Challenges Ahead For Federal Technology Assessment

Abstract

Sean Tunis and colleagues provide an excellent critique of current federal activities to assess new medical technology. These efforts generally do not involve primary data collection but rather reflect attempts to better synthesize existing information, to make conditional coverage decisions based on the data, and to increase coordination among government agencies. Many challenges remain on analytical, logistical, legal, and political fronts. Researchers and analysts should be more precise about what "rapid learning" means and strive to measure performance. Efforts are also needed to prioritize research, to communicate it to decisionmakers, to involve stakeholders in the process, and to include cost-effectiveness information. O n e d o e s n ' t a lways see the words "federal" and "rapid" in such close proximity as in the title of the paper by Sean Tunis and colleagues, so one approaches their paper with a mixture of curiosity and skepticism. 1 The piece, however, provides an excellent critique of current government activities to assess new medical technology. Although the authors sidestep a few thorny issues, they generally make a compelling case that federal policymakers are actively and in some cases creatively attempting to improve efficiency as they attempt to balance rigor and timeliness in technology assessment. Tunis and colleagues catalogue the federal initiatives by type of activity, but they might have divided them into one of three categories: making better use of existing information; developing conditional coverage strategies; and improving coordination across agencies.n Making better use of existing information. Although Tunis and colleagues don't call attention to it, their review underscores an underappreciated phenomenon: Much of the recent activity in evidence policy does not involve primary data collection. Rather, it involves systematically reviewing existing data through evidence syntheses and data-mining techniques, and strengthening available databases. The initiatives of the Agency for Healthcare Research and Quality (AHRQ), stemming from Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, are a prime example. AHRQ has carried out its statutory mandate admirably, through existing infrastructure, such as the Evidence-based Practice w 1 5 0 2 6 J a n u a r y 2 0 0 7 P e r s p e c t i v e s