1. CNESH: Top 10 Process ANDRA MORRISON 14 APRIL, 2015

2. CNESH Process h 1 50 Nominated 48 Filtered 45 Verified Prioritized Top 10 Disseminated Evaluation 2 excluded = 48 28 excluded = 17 7 excluded = 10 3 excluded = 45 Stage 1 Stage 2

3. Nomination Promote call for nominations: Print and social media, CNESH website, RX&D, MEDEC, HTX, CADTH committees, International HS programs, CNESH, word of mouth. Received nominations: 55% industry, 30% professional orgs and networks, 15% clinicians. 2 Nomination Filtration Verification Prioritization Dissemination Evaluation

4. Filtration Criteria Is the technology new and/or emerging? Are compulsory questions appropriately addressed? 3 Nomination Filtration Verification Prioritization Dissemination Evaluation New

5. CNESH Definition of Health Technology Includes: Drugs - biologics, blood products, vaccines and prescription and non- prescription medicines Medical, dental and surgical devices and procedures Diagnostics - lab tests, screening programs and diagnostic imaging Does not include: Health human resources Health system design Electronic health-related technologies 4

6. CNESH Definition of New & Emerging “New” Health Technology A technology that has been approved for clinical use for only a short time. Medical devices may already be marketed, but are less than 10% diffusion or localized to a few centers. Drugs are considered if they have not received Health Canada approval at the prioritization phase of the CNESH Top 10 cycle. Emerging” Health Technology A technology that has not yet been approved by Health Canada. Drugs are usually in Ph II or III of clinical trials, medical devices will be within 6 – 9 months of marketing. Emerging technologies may also include an existing health technology that is being investigated for a new indication. 5

7. Verification Submitted references reviewed and literature search conducted Nomination form reviewed Nomination form key criteria verified Key criteria rated 6 Nomination Filtration Verification Prioritization Dissemination Evaluation

8. Criteria for Assessing Technologies 7 CriteriaScale usedScore Size of population >1,000,000 500,000-999,000 100,000-499,999 50,000-99,999 <50,000 +2 +1 0 -2 Survival (mortality) Safety Effectiveness QOL Significant improvement Minor/moderate improvement No difference Minor/moderate worse Significantly worse +2 +1 0 -2 Upfront cost On-going cost Implementation needs Significantly less Minor/moderate less No difference Minor/moderate more Significantly more +2 +1 0 -2

9. Prioritization: Stage 1 In Out Maybe Nomination Filtration Verification Prioritization Dissemination Evaluation

10. Prioritization: Stage 2 9 Clinical experts: specialists and general practitioners + CNESH Prioritization Committee Review summaries and key articles on nominated technologies

11. Prioritization: Stage 2 Clinical Expert Questions Are you familiar with the technology? Do you consider it to be a potential ‘game changer”? Is the technology already accepted and widely diffused? Does the technology represent a incremental or modest improvement to the SOC? Does it address an unmet need? Does the technology have the potential to have a considerable impact on health outcomes? Will this technology have an impact on the health care delivery infrastructure? 10

12. Prioritization: Stage 2 General practitioners meet with CPC and discuss each technology. Final decision is made by CPC 11

13. Dissemination Launch at CADTH symposium CNESH website Social/print media 12 Nomination Filtration Verification Prioritization Dissemination Evaluation

14. Entire process is evaluated annually – we seek feedback from everyone involved in the process: nominators, experts, verifiers, CNESH members Lessons learnt: Don’t announce the call for nominations during the summer holidays Nominators exaggerate claims Media and their readers love Top 10 lists 13 Nomination Filtration Verification Prioritization Dissemination Evaluation

15. Questions? 14