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A Decision-Making Framework for the Prioritization of Health Technologies
Abstract
During the last two decades most provinces and territories in Canada have created regional or district health authorities with the goal to improve health care provision in a process that has come to be referred to as "regionalization". The district or regional health authorities (RHAs) created through this process were intended to streamline the delivery of health care to make it less fragmented and more integrated across regions and provinces, whilst maintaining local accountability and transparency to health care providers, patients and the public. Regardless of the reasons why regionalization has occurred, it has brought into focus a number of important issues related to decision -making frameworks for Health Technology Assessments (HTAs) and Health Technologies (HTs). Many new health technologies are proposed each year while old technologies require upgrading or replacement. Decision makers face pressures to obtain the safest and most effective HTs within a limited budget. There ought to be objective and transparent guidelines for prioritizing HT expenses. In the past two decades in Canada, the responsibility for these decisions has been devolved from provincial/territorial ministries to district and regional health authorities (RHAs). While regionalization is intended to improve health services according to specific regional needs, the diversity of health authorities has created inconsistent methods for prioritizing HTs. We proposed and tested a method for prioritizing HTs based on a standard set of 11 criteria. We developed consensus on these criteria through key informant interviews and a focus group. Participants from 35 RHAs provided Criteria Surveys, from which relative weights could be calculated based on relative importance of each criterion. The criteria weightings were validated by using experts' ratings of selected HTs at a pilot site. Ratings of HTs on each criteria were consistent with the overall priority assignments provided by the experienced managers, both with and without the importance weights. The importance weights provide an objective standard for discussing the key criteria (and priorities) in health technology assessment.
... For example, the organization may prioritize technologies that benefit disadvantaged populations and may devalue technologies that treat only rare disease conditions, even though each technology may have good evidence for safety and effectiveness. In recent years, there has been interest in Multi-Criteria Decision Analysis to support the adoption or prioritization of health interventions (Shani et al., 2000;Johnson-Masotti and Eva, 2006;Greenberg et al., 2005;Greenberg et al., 2003;Danjoux et al., 2007;Johnson and Backhouse, 2006;Pluddemann et al., 2010). The principles of Multi-Criteria Decision Analysis include establishing agreed-upon criteria a priori, determining the relative importance of these criteria (often by giving them a numerical weighting), developing criteria rating scales that define what conditions need to be met in order for a technology to satisfy each criterion, grading the technology against each criterion, and calculating an overall score. ...
... The literature search and development of the criteria was launched in the spring of 2007, and our review process was completed in the fall of 2008. The initial list of criteria was compiled from nine manuscripts describing criteria for the assessment and/or adoption of health technologies and priority setting processes (Noorani et al., 2007;Shani et al., 2000;Johnson-Masotti and Eva, 2006;Wilson et al., 2007;Mitton et al., 2003b;Mitton et al., 2002;Mussen et al., 2007;Mitton and Donaldson, 2004), the lists of criteria provided by our two external experts, and input from local key informants. The initial list created for distribution contained eight criteria grouped into five major domains and 22 sub-criteria clarifying questions. ...
... To address these issues, the Department of Surgery & Surgical Services in Calgary developed their own Local HTA Decision-Support Program and ensured that the end-users were part of the (Poulin et al., 2011); however, it could be enhanced by the addition of explicit criteria for technology evaluation and tools to facilitate transparent and consistent decision-making. Drawing on several earlier studies utilizing Multi-Criteria Decision Analysis for technology adoption and priority-setting (Baltussen and Niessen, 2006;Gibson et al., 2004;Johnson-Masotti and Eva, 2006), the present study aimed to develop a list of explicit criteria relevant for the local context, use the criteria to create decision-making tools, and integrate these criteria and tools into the Local HTA Decision-Support Program. The literature search and development of the criteria list began in the spring of 2007, and our review process was completed in the fall of 2008. ...
When introducing new health technologies, decision makers must integrate research evidence with local operational management information to guide decisions about whether and under what conditions the technology will be used. Multi-criteria decision analysis can support the adoption or prioritization of health interventions by using criteria to explicitly articulate the health organization's needs, limitations, and values in addition to evaluating evidence for safety and effectiveness. This paper seeks to describe the development of a framework to create agreed-upon criteria and decision tools to enhance a pre-existing local health technology assessment (HTA) decision support program.
The authors compiled a list of published criteria from the literature, consulted with experts to refine the criteria list, and used a modified Delphi process with a group of key stakeholders to review, modify, and validate each criterion. In a workshop setting, the criteria were used to create decision tools.
A set of user-validated criteria for new health technology evaluation and adoption was developed and integrated into the local HTA decision support program. Technology evaluation and decision guideline tools were created using these criteria to ensure that the decision process is systematic, consistent, and transparent.
This framework can be used by others to develop decision-making criteria and tools to enhance similar technology adoption programs.
The development of clear, user-validated criteria for evaluating new technologies adds a critical element to improve decision-making on technology adoption, and the decision tools ensure consistency, transparency, and real-world relevance.
... A diferencia de lo reportado en la literatura, la mayoría de los directores o gerentes de hospitales no tiene un enfoque económico marcado y tampoco se centran en el impacto presupuestario y en la utilización de análisis de costo-efectividad [16][17][18] . ...
Objetivo: una tecnología médica es el conjunto de técnicas, medicamentos, equipos y procedimientos utilizados por los profesionales de la salud en la atención médica. Este estudio busca identificar los criterios de evaluación de nuevas tecnologías en salud que utilizan algunos hospitales.
Metodología: estudio observacional de corte transversal. Se incluyeron todos los directores de hospitales y clínicas del departamento de Antioquia que estuvieran interesados en participar en la investigación. Se aplicó una encuesta de 21 preguntas.
Resultados: el 60 % de los encuestados dio la máxima importancia a la capacidad de producción de daños en la atención de los pacientes; el 90 % tiene en cuenta el criterio de seguridad clínica (éticos y jurídicos) y el 100 % lo hace con la evaluación de costo efectividad. En cuanto al orden de relevancia para la toma de decisiones en la adquisición de nuevas tecnologías, el perfil epidemiológico institucional tuvo mayor calificación.
Conclusiones: las instituciones de salud encuestadas tienen protocolos establecidos para la evaluación de tecnologías. Se identificaron los temas a los que se les da mayor priorización, como son la producción de daños a la atención de pacientes, la seguridad clínica, aspectos éticos y jurídicos, y la evaluación de costo efectividad
... Sin embargo, ha sido sugerido recientemente en otros estudios que la mayoría de los directores de hospitales tienen un enfoque económico bastante marcado y, con frecuencia, se centran en el impacto presupuestario y en el reembolso, mientras que dejan casi de lado el análisis de costo-utilidad y de aspectos sociales, que debería ser parte y preceder al análisis económico [50][51][52] . ...
La rápida evolución de la tecnología y con ella la de los diferentes métodos diagnósticos y terapéuticos ha traído consigo un creciente interés por los profesionales de la salud en disponer de los últimos avances y las mejores tecnologías para atender a los pacientes puesto que, a través de estos recursos, se espera reducir la incertidumbre clínica en cuanto a los diagnósticos y tratamientos. Se reconoce que los avances tecnológicos son, en parte, responsables de mejorar la salud de las comunidades y, en consecuencia, de aumentar la expectativa de vida de la población. Sin embargo, el gran número de innovaciones emergentes hace pensar que debe haber un proceso de selección apropiado por parte de los sistemas de salud para garantizar que se logren en la práctica los beneficios y los propósitos planteados. La selección de las nuevas tecnologías debe incluir tanto el análisis de la tecnología en sí como la comparación con otras; este proceso se denomina Evaluación de tecnologías en salud y tiene un enfoque principalmente macro, es decir, desde agencias de evaluación de carácter nacional que evalúan con el objetivo de regular las inclusiones de tecnologías en los sistemas de salud en Colombia. Se trata de un Plan de beneficios; sin embargo, la disponibilidad de las nuevas tecnologías está en las instituciones de salud e implica una evaluación que regule las tecnologías en este nivel. Internacionalmente esto se reconoce como Evaluación de tecnologías basada en hospitales. Este artículo hace una descripción de las evaluaciones de tecnologías, pero con énfasis en metodologías hospitalarias.
... We developed and field-tested a data-to-decision (D2D) methodology [8], motivated by the industry's need for a transparent and comprehensive approach to tackle the multi-objective medical technology investment problem [9]. To this end, we interviewed executives and surgeons from two hospitals (referred to as Hospital A and B) to learn about their current decision-making practices and challenges. ...
... Noorani et al. (2007) have identified 59 unique priority-setting criteria in their review of eleven HTA agencies. These sets of criteria are undoubtedly useful for the decision makers when evaluating new health technology for adoption (Johnson-Masotti and Eva, 2005). However, to get the information about whether the health technology under consideration complies with the listed criteria, decision makers must turn to HTA. ...
Problem statement: The goal of this study is to extend research on Ev idence-Based Practice (EBP) implementation by examining the decision-making processes for acquiring new health technologies in selected hospitals in Southeast Que ensland, Australia. Both a decision-making model and a mini-Health Technology Assessment (HTA) model guide the approach and analysis in this study. We anticipated that both public and private sector organisations would use HTA as the guideline in decision-making processes to acquire new health technologies. Approach: The data were collected using two methods; document analysis and in-depth, face-to-face interviews. The steps in decision- making processes to acquire new health technologies were identified through content and thematic analysis. The HTA process and mini-HTA checklist were used as a bench mark for decision-making processes. Results: Decision making processes were described as informal in not-for-profit private hospitals and as formal in public hospitals. Decisi ons in not-for-profit private hospitals were driven by business strategy and the cost effectiveness of the technologies. In the public hospital, however, the main factors were safety and clinical effectiveness although budget also has some impact. Decision makers in both types of hospitals were unclear abou t HTA and its agencies. They also were not aware of mini-HTA, even though they were searching for a suitable support tool for decision making. Conclusion : This study identified the impact of HTA and mini-HT A in public and private hospital settings. Findings from this study show that the ev idence from HTA is not fully utilised by decision makers in the hospitals to make informed decisions. Health authorities should play a more active role in educating decision makers at hospital level rega rding health technology assessment. Mini-HTA can be a beneficial tool for decision making processes at hospital level.
... Noorani et al. (2007) have identified 59 unique priority-setting criteria in their review of eleven HTA agencies. These sets of criteria are undoubtedly useful for the decision makers when evaluating new health technology for adoption (Johnson-Masotti and Eva, 2005). However, to get the information about whether the health technology under consideration complies with the listed criteria, decision makers must turn to HTA. ...
Problem statement: The goal of this study is to extend research on Evidence-Based Practice (EBP) implementation by examining the decision-making processes for acquiring new health technologies in selected hospitals in Southeast Queensland, Australia. Both a decision-making model and a mini-Health Technology Assessment (HTA) model guide the approach and analysis in this study. We anticipated that both public and private sector organisations would use HTA as the guideline in decision-making processes to acquire new health technologies. Approach: The data were collected using two methods; document analysis and in-depth, face-to-face interviews. The steps in decision-making processes to acquire new health technologies were identified through content and thematic analysis. The HTA process and mini-HTA checklist were used as a bench mark for decision-making processes. Results: Decision making processes were described as informal in not-for-profit private hospitals and as formal in public hospitals. Decisions in not-for-profit private hospitals were driven by business strategy and the cost effectiveness of the technologies. In the public hospital, however, the main factors were safety and clinical effectiveness although budget also has some impact. Decision makers in both types of hospitals were unclear about HTA and its agencies. They also were not aware of mini-HTA, even though they were searching for a suitable support tool for decision making. Conclusion: This study identified the impact of HTA and mini-HTA in public and private hospital settings. Findings from this study show that the evidence from HTA is not fully utilised by decision makers in the hospitals to make informed decisions. Health authorities should play a more active role in educating decision makers at hospital level regarding health technology assessment. Mini-HTA can be a beneficial tool for decision making processes at hospital level.
... A rapid assessment held in 2007 concluded that the most successful approach to target neonatal mortality in settings such as Nepal, with its limited resources and existing health system, would be through the implementation of existing or previously piloted outreach and community-level interventions into one integrated package. 14 Considering the evidence for impact of the interventions, the percent reduction in all-cause neonatal mortality or morbidity, suitability for Nepal if implemented at scale, cost of implementation and status of or experience with existing interventions in Nepal to date, seven interventions were identified to be delivered as a package, adapting the framework by Johnson-Masotti et al. 16 CB-NCP's overarching goal is to reduce neonatal mortality through high coverage of effective communitybased interventions and strengthen facility-based maternal and newborn services. 15 The package is essentially an amalgamation of successful interventions -from broader, cross-cutting approaches like behaviour change communication to specific interventions like management of sepsis. ...
The Community-based Newborn Care Package is a set of neonatal care interventions to be delivered through the existing government system of facility-based health workers and community based volunteers in Nepal. The package was developed by the government of Nepal in 2007 based on the evidence from Nepal and neighboring countries and designed to be implemented as a comprehensive package to improve newborn survival. This paper reviews the process, progress, and lessons learned from the program design, early-implementation and monitoring and provides future directives to improve upon this integrated package that uses a  continuum of care approach from the pre-pregnancy to neonatal periods by involving the communities, health workers and the private sector.
Keywords: Community-Based Neonatal Care Package; integrated package; Female Community Health Volunteer; neonatal mortality; Nepal.
Background:
This paper presents a generic Multi-Criteria Decision Analysis (MCDA) model for Health Technology Assessment (HTA) decision-making, which can be applied to a wide range of HTA studies, regardless of the healthcare technology type under consideration.
Methods:
The HTA Core Model® of EUnetHTA was chosen as a basis for the development of the MCDA model because of its common acceptance among European Union countries. Validation of MCDA4HTA was carried out by an application with the HTA study group of the Turkish Ministry of Health. The commitment of the decision-making group is completed via an online application of 10 different questionnaires. The Analytic Hierarchy Process (AHP) is used to determine the weights. Scores of the criteria in MCDA4HTA are gathered directly from the HTA report. The performance matrix in this application is run with fuzzy Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), fuzzy Vise Kriterijumska Optimizacija I Kompromisno Resenje (VIKOR), and goal programming MCDA techniques.
Results:
Results for fuzzy VIKOR, fuzzy TOPSIS, and goal programming are 0.018, 0.309, and 0.191 for peritoneal dialysis and 0.978, 0.677, and 0.327 for hemodialysis, respectively.
Conclusions:
Peritoneal dialysis is found to be the best choice under the given circumstances, despite its higher costs to society. As an integrated decision-making model for HTA, MCDA4HTA supports both evidence-based decision policy and the transparent commitment of multi-disciplinary stakeholders.
The objective of this study was to develop a national, prioritized research agenda for advance care planning (ACP). We first identified a list of comprehensive ACP research topics and determined priority criteria through focus groups. We next conducted a survey wherein importance weights were assigned to priority criteria and each ACP topic was rated. We combined weights and ratings into overall scores. A total of 17 ACP topics were developed and placed into four categories: patients and family members, the general public, professionals, and the healthcare system. Four main priority criteria were created: feasibility, consistency with ethical and societal values, economic considerations, and impact. Of the 100 individuals we invited to participate in the survey, 62 accepted. Prioritized topics centred largely on the impact of ACP on health resource utilization, communicating advance care planning across settings, and the preferred manner of engaging patients in ACP.
Health care decision making requires making resource allocation decisions among programs, services, and technologies that all compete for a finite resource pool. Methods of priority setting that use explicitly defined criteria can aid health care decision makers in arriving at funding decisions in a transparent and systematic way. The purpose of this paper is to review the published literature and examine the use of criteria-based methods in 'real-world' health care allocation decisions.
A systematic review of the published literature was conducted to find examples of 'real-world' priority setting exercises that used explicit criteria to guide decision-making.
We found thirty-two examples in the peer-reviewed and grey literature, using a variety of methods and criteria. Program effectiveness, equity, affordability, cost-effectiveness, and the number of beneficiaries emerged as the most frequently-used decision criteria. The relative importance of criteria in the 'real-world' trials differed from the frequency in preference elicitation exercises. Neither the decision-making method used, nor the relative economic strength of the country in which the exercise took place, appeared to have a strong effect on the type of criteria chosen.
Health care decisions are made based on criteria related both to the health need of the population and the organizational context of the decision. Following issues related to effectiveness and affordability, ethical issues such as equity and accessibility are commonly identified as important criteria in health care resource allocation decisions.
In recent years, the quest for more comprehensiveness, structure and transparency in reimbursement decision-making in healthcare has prompted the research into alternative decision-making frameworks. In this environment, multi-criteria decision analysis (MCDA) is arising as a valuable tool to support healthcare decision-making. In this paper, we present the main MCDA decision support methods (elementary methods, value-based measurement models, goal programming models and outranking models) using a case study approach. For each family of methods, an example of how an MCDA model would operate in a real decision-making context is presented from a critical perspective, highlighting the parameters setting, the selection of the appropriate evaluation model as well as the role of sensitivity and robustness analyses. This study aims to provide a step-by-step guide on how to use MCDA methods for reimbursement decision-making in healthcare.
Apesar de sua relevância para a operação dos hospitais, a discussão sobre processo logístico, abastecimento e cadeia de suprimentos em organizações de saúde está notadamente ausente da literatura nacional. O presente artigo descreve uma metodologia para a organização do setor de abastecimento de materiais médico-hospitalares de hospitais públicos, desenvolvida com base em uma abordagem de pesquisaação. A premissa que norteou as intervenções propostas para o setor foi a de que grande parte dos problemas em unidades médico-assistenciais do Sistema Único de Saúde nessa área decorria do fato de setores clínicos e administrativos não se identificarem como uma cadeia produtiva integrada o que os setores clínicos produzem não é transparente para os setores ligados ao abastecimento e vice-versa. São apresentados um histórico do desenvolvimento da metodologia, a descrição de suas principais etapas e uma discussão à luz da literatura recente e de alguns conceitos de qualidade e de gestão da cadeia de suprimentos.
Dit rapport is het resultaat van het project 'Beleidsafwegingskaders voedselkwaliteit'. Doelstelling van dit rapport is het ontwikkelen van denkrichtingen voor een combinatie/ integratie van waarden als veiligheid, gezondheid, dierenwelzijn, natuur en milieu, eerlijke handel en economie in een beleidsafwegingskader rond voedselkwaliteit. De indruk is dat de ontwikkeling van een methodiek voor participatieve multi-criteria analyse kansen biedt om uit te groeien tot een operationeel beleidsafwegingskader voedselkwaliteit
Despite their importance for hospital operations, discussions of healthcare organization logistics and supply and materials management are notably lacking in Brazilian literature. This paper describes a methodology for organizing the supply of medical materials in public hospitals, based on an action-research approach. Interventions were based on the assumption that a significant portion of problems in Brazil's National Health System (SUS) facilities derive from the fact that their clinical and administrative departments do not see themselves as belonging to the same production chain - neither the hospital nor the supply department is aware of what the other produces. The development of the methodology and its main steps are presented and discussed, against a background of recent literature and total quality and supply chain management concepts.
Reviews the literature and shows that under very general circumstances coefficients in multiple regression models can be replaced with equal weights with almost no loss in accuracy on the original data sample. It is then shown that these equal weights will have greater robustness than least squares regression coefficients. The implications for problems of prediction are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objective:
To assess patient preferences regarding the treatment of menorrhagia using the multi-attribute utility methodologies, to produce a clinically applicable scale, and to assess health outcomes following treatment of menorrhagia.
Methods:
Women referred to the gynaecology department for the treatment of menorrhagia were interviewed regarding the effects of menorrhagia on different aspects of their life. Their concerns were categorised into main components of health (domains). The relative importance of each domain was rated by the women using importance points which were distributed to represent the perceived importance of each domain. A series of statements (intra-domain statements) was developed for each domain, which described various possible conditions of that component of health. These were also rated using a one metre visual analogue scale with numerical anchor points at zero (worst) and 100 (best).
Results:
The components of health considered most important were, in order of impact, family life, followed by physical health, work life, psychological health, practical difficulties and social life. The scores for the intra-domain statements were combined into a scale to allow the calculation of a final health state utility for a particular outcome based upon the statements the patient chooses within each domain.
Discussion:
In planning treatment for menorrhagia clinicians can assess a woman's current perception of their health, using a simple to administer clinical scale.
Positron emission tomography (PET) is an expensive diagnostic imaging technology. Despite the long history of PET development, the costs and effectiveness of its use in routine clinical practice remain unknown. Against this background of uncertainty regarding the clinical role of PET, the UK Standing Group on Health Technology requested a review of its current and potential role which would enable research priorities in this area to be established.
This 3-month project had two explicit objectives: (1) to review the state of knowledge regarding the clinical applications of PET; (2) to determine the key health technology assessment (HTA) research questions relating to the use of PET in the UK.
A literature review to ascertain the state of knowledge regarding the clinical applications of PET and a three-round Delphi study to inform the key HTA research questions relating to the use of PET in the UK were undertaken. The results of an earlier systematic review, published by the Veteran's Health Administration (VHA) in the USA in 1996, were used as the starting point for the literature review. The VHA review was updated and extended by means of MEDLINE and Cochrane Library database searches. Participants in the Delphi study were selected by discussion with five individuals in the UK with an interest in, and awareness of, developments in PET. As a result of their suggestions, 43 individuals were initially invited to participate, of whom two did not feel appropriately qualified. Questionnaires were sent by facsimile to all invited participants, who were asked to return the completed forms by facsimile within a week. The content and structure of the Delphi study was informed by the results of the literature review. The responses and comments of the participants were a major source of information for this report.
Clinical applications for PET have been advocated in three broad disease groups: oncology, cardiology and neuropsychiatric disorders. There are currently four PET modalities that need to be considered when assessing its potential clinical role in the UK: full ring PET scanners operating in two or three dimensions (available at five sites); partial ring rotating PET scanners (one currently operating in the UK); coincidence imaging with modified gamma camera technology; and high-energy collimator imaging of 511 keV photons with modified gamma camera technology. There is a paucity of available evidence relating to the cost-effectiveness of the various PET modalities in all of the clinical indications for which the technology is currently being advocated. In addition, many existing reports on the diagnostic accuracy of PET are limited because they are liable to bias and often relate only to very small patient numbers. The results of the Delphi study indicated that the four most important research priorities for the NHS, in descending order of their importance, are: (1) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to determine staging prior to operative intervention for lung cancer; (2) partial ring PET compared with full ring PET in oncology (3) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to stage and monitor treatment response in breast cancer; (4) the relative cost-effectiveness of (a) gamma camera PET using coincidence imaging and (b) 511 keV collimated positron imaging for assessing myocardial viability when selecting patients for revascularisation surgery. Vignettes describing each of the research priorities are provided in the main report.
The findings of this project, which was undertaken rapidly in order to inform HTA research prioritization in the UK, provide a contemporary overview of the potential clinical role for PET in the NHS. Evidence is needed that using PET as a diagnostic
This paper revisits the purposes and achievements of regionalization, a decade after its widespread implementation across Canada, and considers to what extent changes in healthcare concepts, emphasis and delivery can reasonably be attributed to it. The authors address four main questions. What, conceptually, is regionalization in healthcare, and what distinguishes it as a structure? How was regionalization intended to contribute to the achievement of the goals for the health system articulated in the 1980s and 1990s? How has regionalization been implemented in Canada, and how have these factors affected its potential to achieve its intended impact? And finally, with the experience gained over the last decade, how might we now (re)design regionalization to better contribute to health system goals? In Canada, regionalization of healthcare has entailed more than devolution and decentralization of services from provincial governments to regional authorities. It included consolidation of authority from local boards and agencies, and some centralization of services. Regionalization was the remedy proposed for the diagnosis of fragmentation and incoherence made by commissions across the country in the 1980s. Regionalization addressed the organizational dimensions of the perceived problems, but provincial governments added goals unrelated to structural change to its mandate. The authors assess the potential impact of regionalization on health system goals and take stock of current Canadian circumstances. Even where regionalization's impact is theoretically high, there are many practical limits to its effect. Although it can facilitate or impede change, in the end the will and actions of provincial governments, providers and other actors in the health system are fundamental to attaining more substantive goals. Many health reform goals require nothing less than a transformation of how society views health, and in the culture of healthcare delivery. Further, the authors argue that the implementation of regionalization in Canada has been limited. Devolution has typically been halting and provisional; there has been little stability; and there have been constraints on the ability to act. These limitations have reduced its potential effect. The authors conclude with proposals for increasing regionalization's contribution to health reform goals. These include a more stable and transparent provincial-RHA relationship, information and measures to better align resources to needs, increased regional-level system integration and changes to organizational culture and practice in the health system.
To consider how the impact of the NHS Health Technology Assessment (HTA) Programme should be measured. To determine what models are available and their strengths and weaknesses. To assess the impact of the first 10 years of the NHS HTA programme from its inception in 1993 to June 2003 and to identify the factors associated with HTA research that are making an impact.
Main electronic databases from 1990 to June 2005. The documentation of the National Coordinating Centre for Health Technology Assessment (NCCHTA). Questionnaires to eligible researchers. Interviews with lead investigators. Case study documentation.
A literature review of research programmes was carried out, the work of the NCCHTA was reviewed, lead researchers were surveyed and 16 detailed case studies were undertaken. Each case study was written up using the payback framework. A cross-case analysis informed the analysis of factors associated with achieving payback. Each case study was scored for impact before and after the interview to assess the gain in information due to the interview. The draft write-up of each study was checked with each respondent for accuracy and changed if necessary.
The literature review identified a highly diverse literature but confirmed that the 'payback' framework pioneered by Buxton and Hanney was the most widely used and most appropriate model available. The review also confirmed that impact on knowledge generation was more easily quantified than that on policy, behaviour or especially health gain. The review of the included studies indicated a higher level of impact on policy than is often assumed to occur. The survey showed that data pertinent to payback exist and can be collected. The completed questionnaires showed that the HTA Programme had considerable impact in terms of publications, dissemination, policy and behaviour. It also showed, as expected, that different parts of the Programme had different impacts. The Technology Assessment Reports (TARs) for the National Institute for Health and Clinical Excellence (NICE) had the clearest impact on policy in the form of NICE guidance. Mean publications per project were 2.93 (1.98 excluding the monographs), above the level reported for other programmes. The case studies revealed the large diversity in the levels and forms of impacts and the ways in which they arise. All the NICE TARs and more than half of the other case studies had some impact on policy making at the national level whether through NICE, the National Screening Committee, the National Service Frameworks, professional bodies or the Department of Health. This underlines the importance of having a customer or 'receptor' body. A few case studies had very considerable impact in terms of knowledge production and in informing national and international policies. In some of these the principal investigator had prior expertise and/or a research record in the topic. The case studies confirmed the questionnaire responses but also showed how some projects led to further research.
This study concluded that the HTA Programme has had considerable impact in terms of knowledge generation and perceived impact on policy and to some extent on practice. This high impact may have resulted partly from the HTA Programme's objectives, in that topics tend to be of relevance to the NHS and have policy customers. The required use of scientific methods, notably systematic reviews and trials, coupled with strict peer reviewing, may have helped projects publish in high-quality peer-reviewed journals. Further research should cover more detailed, comprehensive case studies, as well as enhancement of the 'payback framework'. A project that collated health research impact studies in an ongoing manner and analysed them in a consistent fashion would also be valuable.
Judgment is an inferential cognitive process by which an individual draws conclusions about unknown quantities or qualities
on the basis of available information. The flaws in an individual’s cognitive process leading to inaccurate judgment have
been explored widely (Hammond, Stewart, Brehmer, & Steinmann, 1986; Hogarth, 1987; Kahneman, Slovic, & Tversky, 1982; Simon,
1945, Simon, 1960). The earliest research on group judgment led to some confidence that the mathematical aggregation of judgments
from several individuals (collected as a “statistized,” “nominal,” or “noninteracting” group) usually would be better than
the accuracy expected by randomly selecting a single individual from the population of all prospective group members (Bruce,
1935; Gordon, 1924; Knight, 1921).
"April 24, 2001." Typescript. Research project--University of Missouri--Columbia, 2001. Includes bibliographical references (leaves 20-21).
This paper reports an analysis done for the Secretaria de Obras Publicas (Ministry of Public Works) of Mexico to help select the most "effective" strategy for developing the airport facilities of the Mexico City metropolitan area to insure quality air service for the remainder of the century. Effectiveness is a complex function including attributes of cost, safety, capacity of the airport facilities, noise levels, social disruption, and access times. A decision analytic model was used for evaluating strategies. The attributes were adapted to account for impacts over time, and probability density functions and a utility function were assessed over the six attributes. Details of these assessments are given. The results and implications of the analyses are discussed. A unique aspect of the study involved the assessment of a multiattribute utility function and its use to aid an important policy decision.
Periodontal health states are difficult to quantify and no formal scale quantifying patients' utilities for periodontal health states exits. Multi-attribute utility (MAU) techniques were used to develop such a scale. The MAU scale may be used to quantify patients' assessment of their current periodontal health and that of possible treatment outcomes. Such data, combined with probability values in formal decision analysis techniques would result in improved rationality of treatment planning for periodontal disease. 20 patients attending for routine undergraduate care were interviewed. Data from these interviews were sorted into groups of common interest (domains). Intra-domain health statements were complied from the interview content. 21 patients ranked the intra-domain statements on a scale of 0-100. This same group of patients also performed an inter-domain weighting. Mean results showed that patients were 2X as concerned with how they felt and with the prognosis of possible outcomes, than with how they looked and what facts they knew about their oral health. However, the real value of utilities research lies in application of individual results to treatment planning as there is a wide range of opinion regarding outcome health states.
Although the broad impacts of Alzheimer's disease (AD) are increasingly recognized, little work has focused on the overall health-related quality of life experienced by Alzheimer's disease patients and their caregivers. The study had two main objectives: (1) to test the feasibility of measuring health utilities in Alzheimer's disease with a generic preference-weighted instrument using proxy respondents and (2) to assess the utility scores of Alzheimer's disease patients (and their caregivers) in different disease stages and care setting.
A cross-sectional study of 679 Alzheimer's disease patient/caregiver pairs was conducted at 13 sites in the United States: four academic medical centers, four managed care plans, two assisted living facilities, and three nursing homes. The Health Utilities Index Mark II (HUI:2) questionnaire was administered to caregivers of patients who responded both as proxies for patients and for themselves. Responses to the questionnaire were converted into a global utility score, between 0 and 1, using the HUI:2 multi-attribute utility function.
Global utility scores varied considerably across patients' Alzheimer's disease stage: for the six stages assessed (questionable, mild, moderate, severe, profound, and terminal), mean utility scores were 0.73, 0.69, 0.53, 0.38, 0.27, and 0.14, respectively. In multiple regression analyses, Alzheimer's disease stage was a negative and significant predictor of utility scores for patients; setting did not exert an independent effect. Utility scores for the caregivers were insensitive to patients' Alzheimer's disease stage and setting.
Patients' Alzheimer's disease stage had a substantial influence on health utilities, as measured by the HUI:2. More research is needed to assess the validity of using proxy respondents.
The developing role and use of diagnostic imaging continue to emerge as disease management paradigms are refined and clinical guidelines are employed more often. Health technology assessment, HTA (also known as health care technology assessment), is fundamentally a form of policy research. By formulating effective HTA, the short- and long-term effects of health care technology are studied in a systematic and multidisciplinary way. The fundamental aim of all HTA is to assist those individuals and organizations who stand to benefit from a new health technology (patients), those who will apply the technology (providers), and those who will pay for it (payers) to make better decisions about the technology they utilize by supplying information that is of a high scientific standard and population-based. Effective HTA is especially useful to health care providers, payers, professional groups in health care, manufacturers, political decision-makers and the general public or consumers of health care technology because it represents a process through which effective technology can be identified and ineffective technology can be understood in the context of its limitations. HTA is a multidisciplinary undertaking requiring combined expertise in clinical medicine, epidemiology, biostatistics, bioengineering, health economics, administration, psychology, sociology, ethics and legal science. Additionally, the experiences and opinions of health technology users and consumers of health care (especially patient advocacy groups) are needed to form an overall accurate understanding of the technology under review.
The rapid development of new and expensive health technologies together with the limited resources available for the health care system, makes priority setting or rationing inevitable. The Israeli Health Insurance Law, enacted in 1995, determined a basic list of health services to be provided to all residents by public funding. Although the Israeli health care system has reached a high standard of medical care as expressed by parameters such as long life expectancy and low infant mortality, the social and professional demand for new and expensive health technologies is increasing. Towards the fiscal year of 1999, the Medical Technologies Administration of the Ministry of Health recommended a list of new technologies to be added to the list of health services. The Ministry of Finance allocated that year US dollars 35 million for this purpose, while a rough assessment found that there are new important technologies to be added at a cost of more than US dollars 350 million. The Medical Technologies Administration took a systematic approach of health technology assessment - ad-hoc teams were established for evaluating clinical safety, efficacy and effectiveness, conducting needs assessment and cost-effectiveness descriptions. Assessment of the data was based on evidence-based medicine. A set of criteria was determined in order to enable the prioritizing of the assessed new technologies. This procedure led to a list of technologies suggested for inclusion. The Minister of Health appointed a public committee whose purpose was to decide the technologies to be added to the list of health services. The committee, made up of representatives from the government, the sick-funds and the public, had to evaluate each technology, based on the analysis submitted to the committee, taking into consideration clinical, economic, social, ethical and legal aspects according to predefined criteria. The thorough work of the Medical Technologies Administration enabled the committee to adopt its recommended list with minor changes within a limited timeframe. In conclusion, we propose a practical and pragmatic model for the inclusion of new health technologies at a national level, based on health technology assessment and explicit priority setting.
In this study the effectiveness of multi-attribute utility (MAU) decision support in groups is evaluated for personnel selection problems differing in complexity. Subjects were asked to make an initial individual decision with or without MAU decision support. Next individuals formed small groups and were asked to reach a decision about the same problem. Groups received either MAU support or no support. Results show that for relativelysimpleproblems the most effective method is to provide subjects with both individualandgroup decision support. Here, decision support had a clear impact on subjects’ preferences and the level of agreement between group members. In addition, satisfaction with the decision and the decision procedure was relatively high. Overall, decision support improved communication; subjects reported to find the problem easier, to have more influence on the group decision, and to find it easier to express their opinions. For morecomplexproblems, however, decision makingwithoutgroup support (whether preceded by individual support or not) was evaluated most favorably. Individual decision support in this condition was sometimes better than no support; i.e., there was a lower reported problem difficulty, a higher satisfaction with the group decision, and a higher reported influence on the group decision. The effectiveness of group MAU decision support for complex problems was evaluated less favorably.
Cooperative agreements for human immunodeficiency virus (HIV) prevention projects, intervention announcement and availability of funds for the fiscal year 1993
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Health technology assessment in the context of the Spanish National Health System (NHS II) Process of elaboration of technical notes and prioritisation
- Jf Alcaide
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- A Andres
- Jl Conde
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Alcaide JF, Lopez-De Andres A, Conde JL, Azocar O. Health technology assessment in the context of the Spanish National Health System (NHS II). Process of elaboration of technical notes and prioritisation. Annual Meeting of International Society of Technology Assessment in Health Care 2000; 15:91.
Public Policy Analysis -An Introduction Englewood Cliffs Keeney RL. A decision analysis with multiple objectives: the Mexico city airport
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Cost-utility assessment: planning with local decision -makers in developing countries
- Spear
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Spear SF, et al. Cost-utility assessment: planning with local decision -makers in developing countries. Public Administration and Development 1988;
The burden of proof: An Alberta model for assessing publicly funded health services
- Alberta Health
Alberta Health and Wellness. The burden of proof: An Alberta model for assessing
publicly funded health services. 2003.
Health technology assessment in the context of the Spanish National Health System (NHS II)
- Jf Alcaide
- A Lopez-De Andres
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- O Azocar
Alcaide JF, Lopez-De Andres A, Conde JL, Azocar O. Health technology
assessment in the context of the Spanish National Health System (NHS II).
Process of elaboration of technical notes and prioritisation
Process of elaboration of technical notes and prioritisation. Annual Meeting of
International Society of Technology Assessment in Health Care 2000; 15:91.
HTA Initiative #7: Local Health Technology Assessment: A Guide for Health Authorities
- Alberta Heritage
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http://www.ahfmr.ab.ca/hta/hta-publications/initiatives/HTA -FR7.pdf. 2002.