Background & Objectives : Korea is faced with the social need for health care technology assessment so that it is urgently needed to found principles and methodology in technology assessment in health care. As a groundwork for health care technology assessment, we tried to prioritize medical technology for assessment. Among medical technologies, procedure is somewhat difficult to assess, compared to drug or equipment. In this study, we aimed at the prioritisation of medical procedure to be assessed, in terms of efficacy, safety, and adequacy.
Method : For the standardized classification of medical procedure, ICD-9-CM(International Classification of Diseases 9th edition - Clinical Modification) was used. Among the list the procedures coming under otorhinolaringology and thoracic surgery were selected by three family phyicians. The list of procedure was mailed to the board certified surgeons of both disciplines, with the question asking about the necessity for assessment in terms of efficacy, safety, and adequacy. Replied questionnaires were analyzed in each procedure.
Results : Of 560 otorhinolaryngologist and 480 thoracic surgeon, 114 surgeons replied. Of otorhinolaryngological procedure, incision, excision, and destruction of inner ear: fenestration of inner ear : stapedectomy and its revision were the most urgent technology to assess in the aspect of safety. For adequacy, operations on Eustachian tube: fenestration of inner ear; incision, excision, and destruction of inner ear were highly ranked in necessity, and for efficacy, operations on Eustachian tube : external maxillary antrotomy: fenestration of inner ear. Thoracic surgeons replied thoracic procedures, lung transplantation: heart transplantation, implantation of heart assist system [pump] are most important for evaluation in terms of safety: and heart transplantation: Lung transplantation: Implantation of heart assist system [pump] in terms of adequacy, and surgical collapse of lung [Artificial pnemothorax or pnuemoperitoeum] : lung transplantation: periarterial sympathectomy in terms of efficacy. As a whole, surgeons regard safety evaluation is more urgent than adequacy or efficacy. In addition, otorhinolaryngological surgeons regard evaluation of their procedures more urgent than thoracic surgeons regard theirs.
Conclusion : By the questionnaire to board certified physicians, we get some preliminary data for prioritisation of technologies to assess. Through the questionnaire like this, much information would be gathered for technology assessment, especially for medical Procedure, if not enough. In the near future, well structured expert opinion gathering research, such as modified Delphi or nominal group technique, should be done succeedingly.
|