Background: The value of health technology change depends upon its life-cycle. A health technology reassessment (HTR) is essential in terms of overall life-cycle management of the health technology. Meanwhile, the National Evidence-based Healthcare Collaborating Agency has developed a system and execution model for HTR and two health technologies were prioritized for pilot studies.
Objectives: To establish a system for HTR suited to a local healthcare system through pilot technology assessments and appraisals.
Methods: We performed systematic reviews and analysis using national health insurance claims data for two selected health technologies (capsule endoscopy for suspected small bowel disease, steroid intradiscal therapy (SIDT) for back pain) to describe basic information about burden of disease or medical service utilization and to compare healthcare outcomes of interventions of interest. We developed the process and tools for grading of recommendation and operated the HTR's specialized committee. We proposed the grading of recommendation for reassessed technologies using the draft of a recommendation system established on the basis of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results: Capsule endoscopy for the suspicion of Crohn's disease and obscure gastrointestinal bleeding (OGIB) was clinically safer and more effective than conventional treatments such as push endoscopy or small bowel barium follow-through etc.). The scientific evidence was insufficient for the risk and benefits of SIDT, which has been performed in only four hospitals. The appraisal tool was developed based on the Evidence to Decision framework and applied with the reassessment results through the HTR's specialized committee. The committee derived the grading of recommendation through face-to-face meetings. A decision was reached in favor of the use of capsule endoscopy for OGIB (weakly for), and against the use of SIDT (weakly against).
Conclusions: We suggest the grading of recommendation system for Korean HTR model and revision of the proposed model to enhance its acceptability and suitability within the local healthcare system.