One of the principal challenges in producing current and timely appraisals of new and emerging healthcare interventions is the continued innovation and evolution of treatment for the condition being appraised.  All comparative effectiveness appraisals are “point in time” efforts, and must therefore be revisited often to ensure that they remain relevant to the current conditions in a particular therapeutic area.

While ICER has previously developed appraisal updates on an as-needed basis, such as when the results of a major multicenter study have been released, we recognize the need to provide updates in a more standardized and consistent fashion.  Accordingly, ICER will undertake the following process for each appraisal conducted:

• One year after posting the final appraisal document (FAD), the original search strategy will be re-run to identify all relevant studies published in the intervening timeframe.  This search will be supplemented by a review of references, news items, Web searches, and other information-gathering exercises as appropriate.
• The ICER team will identify studies of potential interest from this search.  ICER will then communicate with a core group of experts from the original Evidence Review Group (ERG) to solicit feedback on any issues or concerns with the identified studies, any important studies or presentations that were missed by the search, and key considerations in determining if the new evidence may materially affect the original findings.
• Based on the guidance received from the ERG members, ICER will decide whether to revise the appraisal.  If revision of the original FAD is warranted, the interim evidence will be evaluated to determine whether modifications to the major findings and conclusions of the original report are necessary.  The rationale behind the decision to open a formal revision or not will be posted on the ICER website along with a review of new interim findings and any subsequent changes to the major findings and conclusions of the original appraisal.
• A multi-pronged approach will be taken for further updates, as follows:
  • For appraisals in active policy use by patients, clinicians, and/or payers:  annual updates for a period of 3 years, after which continued interest in the appraisal topic will require a new appraisal
  • For appraisals not in active policy use:  no further updates after one year

Last updated July 11, 2011