Technology Evaluation
Center (TEC)

Founded in 1985 by the Blue Cross and Blue Shield Association, the Technology Evaluation Center (TEC) pioneered the development of scientific criteria for assessing medical technologies through comprehensive reviews of clinical evidence. TEC operates as part of the Association's Office of Clinical Affairs.

Since its inception, TEC has been recognized for leadership in producing evidence-based technology assessments. Each TEC Assessment is a comprehensive evaluation of the clinical effectiveness and appropriateness of a given medical procedure, device or drug. Averaging 20 to 25 assessments a year, TEC provides healthcare decision makers with timely, rigorous and credible information on clinical effectiveness. TEC serves a wide range of clients in both the private and public sectors, including Kaiser Permanente and the Centers for Medicare and Medicaid Services (CMS).

TEC Assessments are scientific opinions, provided solely for informational purposes. TEC Assessments should not be construed to suggest that the Blue Cross Blue Shield Association, Kaiser Permanente Medical Care Program or the TEC Program recommends, advocates, requires, encourages, or discourages any particular treatment, procedure, or service; any particular course of treatment, procedure, or service; or the payment or non-payment of the technology or technologies evaluated.

Staff

TEC is headed by Executive Director, Naomi Aronson, Ph.D. Its core staff of research scientists consists of experienced physicians and doctorate-level scientists with a history of academic and primary research affiliations. They are also supported by professionals in pharmacology, nursing, statistical methods and library science, and represent a multitude of clinical and methodological disciplines that are integral to performing technology assessments.

A Medical Advisory Panel, comprising independent, nationally recognized experts in technology assessment, clinical research and medical specialties, has scientific accountability for all TEC assessments. The 19-member panel meets three times a year to review TEC Assessments and judge the quality of evidence and the relative weights of the potential benefits and harms. The Panel includes appointees from the American Collegeof Physicians, American Collegeof Medical Genetics, American Academyof Family Physicians, American College of Cardiology, American Academyof Pediatrics, and American College of Surgeons. Panel members who are specialty society appointees render independent judgments regarding issues presented to the MAP; the results of TEC Assessments and Special Reports should not be construed either to be endorsed or approved by the individual appointing specialty societies.

Following each Medical Advisory Panel meeting, TEC publishes the preliminary executive summaries of the reviewed assessments as TEC Assessments In Press.

TEC Special Assessments

TEC Assessments routinely use the five TEC criteria to evaluate whether drugs, devices, procedures and biological products improve health outcomes such as length of life, quality of life and functional ability. On occasion, TEC issues special assessments that examine how a technology is applied in a broader context. These special assessments might address how to manage the care of a specific population. Other times they may compare the relative effectiveness of different clinical approaches or analyze the cost-effectiveness of technologies.

TEC's collaborative relationship with Kaiser Permanente began in 1993. As a result of TEC's collaboration with Kaiser, David M. Eddy, M.D., Ph.D., Senior Advisor for Health Policy and Management, Care Management Institute, The Permanente Federation, served for over 10 years as TEC's Scientific Advisor, until his retirement from the position in 2004. In addition, one Permanente physician, Jo Carol Hiatt, M.D., is a voting member of TEC's Medical Advisory Panel. Dr. Hiatt is the Chair of the Interregional New Technologies Committee and the Chair of the National Product Council from The Permanente Federation.

TEC Assessments and other publications are provided to Kaiser Permanente staff. Dr. Hiatt participates actively in the MAP discussions, sharing clinical opinion from Permanente physicians on the draft TEC products. TEC staff works with Kaiser Permanente's Technology Assessment staff to obtain input on topic selection and to gain access to Permanente's physician experts on a wide range of topics. Permanente clinical expertise may be used to help shape the actual research questions in TEC Assessments. In many cases, these physicians either chair or sit on committees that are responsible for developing practice guidelines.

Evidence-based medicine is commonly defined as “The conscientious, explicit, and judicious use of current evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett DL, Straus S, Richardson S, Rosenberg W, Haynes RB. Evidence-based Medicine: how to practice and teach EBM, ed 2. London: Churchill Livingston, 2000.)

The concept of evidence-based medicine provides the foundation of TEC assessments. TEC's mission is to provide healthcare decision makers with timely, objective and scientifically rigorous assessments that synthesize the available evidence on the diagnosis, treatment, management and prevention of disease.

This information also allows patients to participate in the medical decision-making process with their physicians. By sharing in the decision making, patients can express their personal preferences and goals that underline how they would like their treatment handled.

How shared decision making between patients and physicians has evolved in the healthcare system is the subject of the article Finding a Balance.

In 1997, TEC was designated as one of 12 original Evidence-based Practice Centers (EPCs) for the federal Agency for Healthcare Research and Quality (AHRQ). TEC was first awarded a 5-year contract renewal in 2002 and another in 2007 and now serves as one of 14 current EPCs. In 2009, TEC was awarded a special designation as an EPC dedicated to developing comprehensive comparative effectiveness reviews in cancer and infectious diseases. The findings of the EPCs provide the foundation on which organizations - such as physician specialty societies - develop clinical practice guidelines, as well as tools and strategies for improving the quality of healthcare services.

Sixteen evidence reports have been provided to AHRQ; most can be viewed on the AHRQ Web site or AHRQ's Effective Health Care Program site.

• Relative Effectiveness and Cost-Effectiveness of Methods of Androgen Suppression in the Treatment of Advanced Prostatic Cancer
• Uses of Epoetin for Anemia in Oncology
• Uses of Epoetin in Patients with Chronic Renal Failure
• The Management of Chronic Asthma
• FDG Positron Emission Tomography for Evaluating Breast Cancer
• Endoscopic Retrograde Cholangiopancreatography
• Islet Transplantation for Type 1 Diabetes Mellitus
• Wound-Healing Technologies: Low-Level Laser and Vacuum-Assisted Closure
• Management of Small Cell Lung Cancer
• Comparative Effectiveness of Epoetin and Darbepoetin for Managing Anemia in Patients Undergoing Cancer Treatment
• Treatment of Primary and Secondary Osteoarthritis of the Knee
• HER2 Testing to Manage Patients with Breast or Other Solid Tumors
• The Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer
• Technology Assessment:  Bone Morphogenetic Protein
• Technology Assessment: Provenge
• Comparative Effectiveness of Hematopoietic Stem-Cell Transplant for Pediatric Indications

• TEC Assessments (sorted by Volume)
• TEC Assessment Format
• TEC Assessment Process
• TEC Assessments In Press

The Technology Evaluation Center (TEC) creates nationally respected evidence-based assessments of medical technologies. TEC produces 20 to 25 assessments each year for subscribers. Each assessment is a comprehensive evaluation of the clinical effectiveness and appropriateness of a given medical technology. These assessments are written by TEC's core staff. TEC is composed of experienced physicians and doctorate-level scientists with a history of academic and primary research affiliations and is guided by the Medical Advisory Panel (MAP). The MAP is composed of nationally respected physician experts, and has final scientific and clinical authority for all TEC assessments.

The TEC Program uses five criteria to assess whether a technology improves health outcomes such as length of life, quality of life and functional ability. TEC also uses a formal approach when reviewing the evidence, and all reports are written using a structured format.

The Blue Cross and Blue Shield Association uses the five criteria below to assess whether a technology improves health outcomes such as length of life, quality of life and functional ability.

1. The technology must have final approval from the appropriate governmental regulatory bodies.

• This criterion applies to drugs, biological products, devices and any other product or procedure that must have final approval to market from the U.S. Food and Drug Administration or any other federal governmental body with authority to regulate the technology.
• Any approval that is granted as an interim step in the U.S. Food and Drug Administration's or any other federal governmental body's regulatory process is not sufficient.
• The indications for which the technology is approved need not be the same as those which Blue Cross and Blue Shield Association's Technology Evaluation Center is evaluating.

2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes.

• The evidence should consist of well-designed and well-conducted investigations published in peer-reviewed journals. The quality of the body of studies and the consistency of the results are considered in evaluating the evidence.
• The evidence should demonstrate that the technology can measure or alter the physiological changes related to a disease, injury, illness, or condition. In addition, there should be evidence or a convincing argument based on established medical facts that such measurement or alteration affects health outcomes.
• Opinions and evaluations by national medical associations, consensus panels, or other technology evaluation bodies are evaluated according to the scientific quality of the supporting evidence and rationale.

3. The technology must improve the net health outcome.

• The technology's beneficial effects on health outcomes should outweigh any harmful effects on health outcomes.

4. The technology must be as beneficial as any established alternatives.

• The technology should improve the net health outcome as much as, or more than, established alternatives.

5. The improvement must be attainable outside the investigational settings.

• When used under the usual conditions of medical practice, the technology should be reasonably expected to satisfy TEC criteria #3 and #4.

TEC is guided by the Medical Advisory Panel (MAP), which is composed of nationally respected physician experts. The MAP has final scientific and clinical authority for all TEC assessments. Chaired by the Senior Vice President, Office of Clinical Affairs, Blue Cross Blue Shield Association, the MAP comprises experts in technology assessment, clinical research methodology and implementation and clinical practice. MAP membership is diversified to ensure representation by a wide variety of viewpoints within the healthcare community. A majority of members hold academic appointments and are independent medical experts without affiliation to healthcare payers.

Chairman

• Allan M. Korn, M.D., F.A.C.P.  Senior Vice President, Office of Clinical Affairs/Medical Director, Blue Cross Blue Shield Association:
• Former Vice President and Chief Medical Officer of Blue Cross Blue Shield ofIllinois(1996–1999)
• Former Senior Vice President, Medical Affairs, Premier HealthAlliance(Premier/AmHs/SunHealth) and Principal, William H. Mercer, Inc.
• Member of work groups/committees at the Centers of Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA)
• Oversees the National Council of Physician Executives, senior BCBS Plan physicians that advise the Association
• Member of the American Medical Association and the Board of Directors of e-Health Initiative
• Serves on the Steering Committee of Connecting for Health and theInstituteofMedicine’s Forum on Drug Discovery
• Fellow of the American College of Physicians/American Society of Internal Medicine
• Board-certified by the American Board of Internal Medicine

Co-Scientific Advisors

Steven N. Goodman, M.D., M.H.S., Ph.D.  Dean for Clinical and Translational Research, Stanford University School of Medicine, Professor, Departments of Medicine, Health Research and Policy:

Specialty:  Pediatrics, Biostatistics, Epidemiology

Mark A. Hlatky, M.D.  Professor of Health Research and Policy and of Medicine (Cardiovascular Medicine),StanfordUniversitySchool of Medicine:

Specialty: Cardiology