To the Editor:

Thank you for the opportunity to respond to the letter by Gibson and Little. The authors raise several points that require a response. First, they claim that we inaccurately characterized the DERP/Washington State Medicaid agency, and did not appreciate that the DERP and the Washington State Medicaid agency have different missions. On the contrary, however, we fully recognized that DERP's mission is to conduct systematic reviews and not to make recommendations, whereas Washington State uses the reviews in making recommendations for their Medicaid enrollees. We specifically noted in the study that “Washington Medicaid is one of fourteen participants in the DERP. DERP researchers conduct health technology assessments for drug classes. Participants in the DERP, such as the Washington Medicaid program, retain local authority for interpreting DERP reports and for decision making regarding which drugs to pay for.” We chose to analyze DERP/Washington State as a single entity for our exercise because we were interested in analyzing the link between the HTA conducted and the decisions that follow them.

Second, Gibson and Little state that we applied our principles in an ad hoc way and should have labeled it as a commentary. In fact, we stated clearly and prominently in the abstract of the article and in text itself that our piece was intended as a commentary. Moreover, we emphasized that our study was intended as a first-blush effort to analyze the support and use of the Key Principles for HTA, and that our focus was on uptake and use of the Principles, rather than a verdict or report card on the HTA entities evaluated. We emphasized that our goal was to advance the practice of HTA and to stimulate informed discussion through an extended and interactive process. Indeed, we view the Gibson and Little letter, despite their criticism, as a symbol of some success in this regard. In addition, several of the other organizations featured in the study contacted us directly with positive feedback, even if they did not agree with all of our observations. In some cases, our study provoked a debate about the key principles within these organizations.

Third, regarding whether the DERP/Washington State supports certain principles, such as explicitly characterizing uncertainty or considering issues of generalizability and transferability, we stick to our judgments, but recognize, as we did in our study, that there is room for debate on such matters. Our study acknowledges that there is subjectivity in our evaluations and that other researchers or the agencies themselves may be more or less strict about whether a particular principle has been supported or implemented. In some cases, we judged our assessments to be more or less straightforward, while in others the evaluation required greater discretion, and caused considerable debate within the group.

Fourth, we agree with Gibson and Little that work on validation of the key principles is warranted. We stressed in our study that in the future researchers might also consider how to undertake formal benchmarking exercises. We stated that it would be useful to pre-specify and quantify more precisely the criteria for achieving a positive verdict on support and use of the principles, and that some principles will lend themselves more readily to such benchmarking than others.

Finally, regarding any use of our study by industry lobbyists in Oregon and Washington, none of us had any involvement in, nor prior awareness of, those efforts.