Can the observed benefit be achieved outside the investigational setting?
Technology that meets the above criteria will generally be medically appropriate for use in applicable clinical settings. The converse, however–ie, when technology fails to meet one or more of these criteria–presents a more complicated situation. Within KP and the INTC, the overall evidence is weighed before clinicians are given a recommendation about the general appropriateness of using the technology. Technology that fails to meet the BC-BS Technology Evaluation Center criteria may be characterized as not medically appropriate for general use by KP members. When technology produces conclusive evidence of no effect (ie, no benefit) or evidence of net harm, the technology is characterized as generally inappropriate for use by KP Health Plan members. This circumstance may also be reflected in health plan coverage as communicated to members and purchasers: ineffective therapies may be excluded from benefit coverage. However, “insufficient evidence” (eg, failure to meet the second crite
