The computer software application developed for prioritisation of potentially obsolete health technologies allows the user to define robustly the technology that meets most requirements for being assessed first. By having a number of criteria grouped in domains, the tool enables each domain’s relative importance in the total to be quantified and weighted. The importance of the different domains is similar, since the maximum difference among domain weightings is 10%. The prioritisation application may be used by any centre, institution or person interested in prioritising potentially obsolete health technologies, and could be extrapolatable to other settings similar to Spain.
In the authors’ opinion the tool possesses external validity, in that it is applicable to other prioritisation contexts for two fundamental reasons: members of almost all Spanish agencies and technology assessment units participated in drawing it up; and, furthermore, account was taken of the opinions and weightings of the various parties, such as clinicians, managers/administrators and end-users, who are implicated in assessment of obsolete health technologies and could benefit from their detection and exclusion from the service portfolio. Somewhat surprisingly perhaps, the weightings of each of these groups were not very different, which made it easier for the scale to be finalised in a way that embraced all their opinions. Despite the fact that a higher score would have been expected to be obtained from managers for the costs and organisation section, this did not prove to be the case. Similarly, patients would have been expected to score the risks domain higher, something that, again, did not happen. Although it might be thought that the patients consulted do not represent other patients from other countries or health-care settings (such as the USA), we feel that, insofar as assessment of obsolete technologies is concerned, great differences in patient scores are not to be expected. At all events, the methodology used for selection and assessment of criteria could be a benchmark for their application in specific contexts, if it is thought that these might be very different. A further aspect to be borne in mind would be a case where the assessments are made at a given time and in a given social context, inasmuch as the latter factors might have an influence on the results, or perhaps the importance of the criteria applied and the weightings allocated might vary with the passage of time.
This prioritisation tool also has limitations, one of which is that it has not yet been used under real conditions. Another limitation is that 10 criteria may prove too many when it comes to prioritising obsolete health technologies: if the number of technologies to be prioritised is high, these 10 criteria would have to be covered for each technology, so that the time needed to conclude the prioritisation process could prove extremely long. Furthermore, to be able to score some of the criteria, users of the tool might find themselves faced with the need to consult the literature. It is also true, however, that this workload would be relatively short compared to the length of time required to draw up a report on a potentially obsolete technology. In addition, we feel that the time invested would be more than recouped by making a rigorous prioritisation that took into account all aspects connected with obsolete health technologies. If shorter and less comprehensive prioritisation questionnaires were used, relevant aspects for prioritisation might well be overlooked.
The tool developed is applicable to obsolete health technologies, whether therapeutic or diagnostic, with it being possible for both types of technologies to be prioritised jointly. An effort was also made to ensure that the tool would prove user-friendly through the use of clear wording; and that it would be highly descriptive, through the generation of figures which made it possible for the assessed technologies to be compared, both overall and in terms of specific aspects. Hence if, say, in any given technology the costs domain had an excessive weight vis-ŕ-vis the other domains, this aspect would be easily identifiable in the tool and so enable the necessary decisions to be taken; and something similar would happen if the risk/benefit domain also had considerable weight in prioritisation for some specific technology.