International Journal of Technology Assessment in Health Care, 28:3 (2012), 339–346. c  Cambridge University Press 2012 doi:10.1017/S026646231200027X Using Best-Worst Scaling in Horizon Scanning for Hepatocellular Carcinoma Technologies Gisselle Gallego Johns Hopkins Bloomberg School of Public Health email: g.gallego@uws.edu.au John F.P. Bridges Johns Hopkins Bloomberg School of Public Health Terry Flynn University of Technology Sydney Barri M. Blauvelt University of Massachusetts; Innovara, Inc. Louis W. Niessen Johns Hopkinks Bloomberg School of Public Health; University of East Anglia and University of Cambridge Objectives: There is a growing need for efficient procedures for identification of emerging technologies by horizon scanning systems. We demonstrate the value of best-worst scaling (BWS) in exploring clinicians’ views on emerging technologies that will impact outcomes in hepatocellular carcinoma (HCC) in the next 5 to 10 years. Methods: Clinicians in Asia, Europe, and the United States were surveyed and their views about eleven emerging technologies relevant to HCC were explored using BWS (case 1). This involved systematically presenting respondents with subsets of five technologies and asking them to identify those that will have the most and least impact on HCC within 5 to 10 years. Statistical analysis was based on sequential best-worst and analyzed using conditional logistic regression. Results: A total of 120 clinicians uniformly distributed across ten countries completed the survey (37 percent response rate). Respondents were predominately hepatologist (41 percent) who focused on HCC (65 percent) and had national influence in this field (39 percent). Respondents viewed molecular targeted therapy (p < .001) and early detection of HCC (p < .001) as having most potential, while improved surgical techniques (p < .001) and biopsy free HCC diagnostics (p < .001) were viewed upon negatively. Conclusions: We demonstrate that BWS could be an important research tool to facilitate horizon scanning and HTA more broadly. Our research demonstrates the value of including clinicians’ preferences as a source of data in horizon scanning, but such methods could be used to incorporate the opinions of a broad array of stakeholders, including those in advocacy and public policy. Keywords: Health technology assessment, Liver cancer, Preferences, Best-worst scaling, Horizon scanning, Hepatocellular Carcinoma Hepatocellular carcinoma (HCC), the predominant form of liver cancer, is one of the most common and lethal malignancies worldwide. The majority of patients with HCC are diagnosed in the advanced stages of presentation due to the relative paucity of symptoms in the early stages. As a consequence and due to the multifocal and advanced stage of disease at time of diag- nosis, potentially curative treatment for HCC is not feasible in 80 percent of patients (23). Current treatments for HCC include surgical resection, liver transplantation, and ablation therapy. Inoperable or unresectable tumors are treated with transcatheter arterial chemoembolization (TACE). Unlike other cancers, the effectiveness of chemotherapy is limited, however, newer agents are emerging and expected to have an impact on treatment out- comes (10). Several technologies that are emerging in this field have been identified by horizon scanning systems (HSSs) (see for example Reference 1). The authors thank Innovara, Inc., especially Samir Podder, Aaron Carpenter, and Alejandro Lemus, for their research assistance. We also thank the respondents who participated in the study without any form of compensation. This study was funded in part by Bristol-Myers Squibb. The funders had no role in study design, data collection and analysis, selection of respondents, decision to publish, or preparation of the manuscript. HORIZON SCANNING For many years, health technology assessment (HTA) agencies have been interested in early identification and monitoring of new and emerging technologies. However, in practice, HTA focuses on established technologies, identifying emerging and new technologies before they are licensed or launched; priori- tizing, assessing, and disseminating the information to decision makers is the function of HSSs. According to Douw et al., the aim of HSS is to assist control and “rationalize the adoption and diffusion of new technologies in health care prac- tice” (5). Horizon scanning usually involves regular searches of different information sources, such as medical news, clin- ical literature, as well as contacts with industry, researchers, and clinical experts. Technologies identified by horizon scan- ning systems might be monitored for assessment in the future or prioritized for early assessment (18). For example, in the United Kingdom new pharmaceuticals identified by the Na- tional Horizon Scanning Centre (NHSC) are reviewed by the National Institute for Health and Clinical Excellence (NICE) to determine whether appraisal or guidance for clinical practice is needed (17). Furthermore, the International Information Net- work on New and Emerging Health Technologies (EuroScan) has currently seventeen members based in fourteen countries. 339