There are many obsolete health technologies that are being used in clinical practice to a greater or lesser extent. Pilot experiences conducted for this project indicate that, if a network of experts is asked to identify obsolete technologies, a number of these will indeed be detected (see Section 2.4.4 of this guide). However, not all such potentially obsolete technologies are going to have the same impact and, by extension, the same priority when it comes to being evaluated, for different reasons. In the first place, the most important reason for prioritising the assessment of a potentially obsolete technology is the expected impact of its funding being withdrawn. The greater the expected impact (impact being understood to mean a major reallocation of resources or a major improvement in a given procedure’s safety or effectiveness), the higher the priority for assessing a health technology for definitive classification as obsolete. A technology also enjoys priority, even though it may be used on only a small number of patients (e.g., for a rare disease), if there is an alternative treatment which represents a substantial gain in quality of life for the patient.
Accordingly, two aspects have been highlighted which are important when it comes to prioritising the assessment of a potentially obsolete technology, namely: financial and organisational aspects; and safety. In addition, there are also aspects of an ethical and cultural nature and, needless to say, those pertaining to the technology’s effectiveness.
When prioritisation activities affecting health are undertaken (investment, allocation of budgets, disinvestment, or exclusion from the service portfolio), it is essential to have access to the opinions and assessments of persons who use and manage health services (administrators/managers, clinicians and end-users), since a broader overview is thus obtained of those aspects which such people would consider most important for the purpose of prioritising obsolete health technology assessment.
The working group agreed to use a specific qualitative methodology for the prioritisation of potentially obsolete health technologies, certain aspects of which were applied by the technical team. The developed methodology makes it possible to integrate the opinions of managers, clinicians and endusers in different autonomous regions, who were selected at the suggestion of the members of the working group.