Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-20T05:42:50.508Z Has data issue: false hasContentIssue false
  • English
  • Français

WHICH CRITERIA ARE CONSIDERED IN HEALTHCARE DECISIONS? INSIGHTS FROM AN INTERNATIONAL SURVEY OF POLICY AND CLINICAL DECISION MAKERS

Published online by Cambridge University Press:  02 December 2013

Nataly Tanios ,
Monika Wagner ,
Michèle Tony ,
Rob Baltussen ,
Janine van Til ,
Donna Rindress ,
Paul Kind ,
Mireille M. Goetghebeur  and
the International Task Force on Decision Criteria
Nataly Tanios
Affiliation:
University of Montreal; EVIDEM Collaboration
Monika Wagner
Affiliation:
LA-SER Analytica
Michèle Tony
Affiliation:
University of Montreal; EVIDEM Collaboration
Rob Baltussen
Affiliation:
Radboud University Nijmegen Medical Centre
Janine van Til
Affiliation:
University of Twente
Donna Rindress
Affiliation:
LA-SER Analytica
Paul Kind
Affiliation:
University of York
Mireille M. Goetghebeur
Affiliation:
University of Montreal; LA-SER Analytica
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The aim of this study was to gather qualitative and quantitative data on criteria considered by healthcare decision makers.

Methods: Using snowball sampling and an online questionnaire with forty-three criteria organized into ten clusters, decision makers were invited by an international task force to report which criteria they consider when making decisions on healthcare interventions in their context. Respondents reported whether each criterion is “currently considered,” “should be considered,” and its relative weight (scale 0–5). Differences in proportions of respondents were explored with inferential statistics across levels of decision (micro, meso, macro), decision maker perspectives, and world regions.

Results: A total of 140 decision makers (1/3 clinical, 2/3 policy) from 23 countries in five continents completed the survey. The most relevant criteria (top ranked for “Currently considered,” “Should be considered,” and weights) were Clinical efficacy/effectiveness, Safety, Quality of evidence, Disease severity, and Impact on healthcare costs. Organizational and skill requirements were frequently considered but had relatively low weights. For almost all criteria, a higher proportion of decision makers reported that they “Should be considered” than that they are “Currently considered” (p < .05). For more than 74 percent of criteria, there were no statistical differences in proportions across levels of decision, perspectives and world regions. Statistically significant differences across several comparisons were found for: Population priorities, Stakeholder pressure/interests, Capacity to stimulate research, Impact on partnership and collaboration, and Environmental impact.

Conclusions: Results suggest convergence among decision makers on the relevance of a core set of criteria and on the need to consider a wider range of criteria. Areas of divergence appear to be principally related to contextual factors.

Keywords

CriteriaDecision makingPriority settingMulticriteriaHealth care
Type
Policies
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 4 , October 2013 , pp. 456 - 465
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Baltussen, R, Niessen, L. Priority setting of health interventions: The need for multi-criteria decision analysis. Cost Eff Resour Alloc. 2006;4:14.CrossRefGoogle ScholarPubMed
2.Daniels, N, Sabin, J. Limits to health care: Fair procedures, democratic deliberation, and the legitimacy problem for insurers. Philos Public Aff. 1997;26:303–350.CrossRefGoogle ScholarPubMed
3.Culyer, AJ, Bombard, Y. An equity framework for health technology assessments. Med Decis Making. 2012;32:428–441.CrossRefGoogle ScholarPubMed
4.Phillips, LD, Fasolo, B, Zafiropoulos, N, Beyer, A. Is quantitative benefit-risk modelling of drugs desirable or possible? Drug Discov Today Technol. 2011;8:e3–e10.CrossRefGoogle Scholar
5.Burls, A, Austin, D, Moore, D. Commissioning for rare diseases: View from the frontline. BMJ. 2005;331:1019–1021.CrossRefGoogle ScholarPubMed
6.Bowen, S, Zwi, AB. Pathways to “evidence-informed” policy and practice: A framework for action. PLoS Med. 2005;2:e166.CrossRefGoogle ScholarPubMed
7.Browman, GP, Manns, B, Hagen, N, et al.6-STEPPPs: A modular tool to facilitate clinician participation in fair decisions for funding new cancer drugs. J Oncol Pract. 2008;4:2–7.CrossRefGoogle ScholarPubMed
8.Goetghebeur, M, Wagner, M, Khoury, H, et al.Evidence and value: Impact on DEcisionMaking - the EVIDEM framework and potential applications. BMC Health Serv Res. 2008;8:270.CrossRefGoogle ScholarPubMed
9.Golan, OG, Hansen, P. Which health technologies should be funded? A prioritization framework based explicitly on value for money. Isr J Health Policy Res. 2012;1:44.CrossRefGoogle ScholarPubMed
10.Honore, PA, Fos, PJ, Smith, T, Riley, M, Kramarz, K. Decision science: A scientific approach to enhance public health budgeting. J Public Health Manag Pract. 2010;16:98–103.CrossRefGoogle Scholar
11.Johnson, AP, Sikich, NJ, Evans, G, et al.Health technology assessment: A comprehensive framework for evidence-based recommendations in Ontario. Int J Technol Assess Health Care. 2009;25:141–150.CrossRefGoogle ScholarPubMed
12.Tannahill, A. Beyond evidence–to ethics: A decision-making framework for health promotion, public health and health improvement. Health Promot Int. 2008;23:380–390.CrossRefGoogle ScholarPubMed
13.Wilson, EC, Rees, J, Fordham, RJ. Developing a prioritisation framework in an English Primary Care Trust. Cost Eff Resour Alloc. 2006;4:3.CrossRefGoogle Scholar
14.Goetghebeur, MM, Wagner, M, Khoury, H, et al.Combining multicriteria decision analysis, ethics and health technology assessment: Applying the EVIDEM decisionmaking framework to growth hormone for Turner syndrome patients. Cost Eff Resour Alloc. 2010;8:4–18.CrossRefGoogle ScholarPubMed
15.Guindo, LA, Wagner, M, Baltussen, R, et al.From efficacy to equity: Review of decision criteria used in resource allocation and healthcare decisionmaking. Cost Eff Resour Alloc. 2012;10:9.CrossRefGoogle ScholarPubMed
16.Mirelman, A, Mentzakis, E, Kinter, E, et al.Decision-making criteria among national policymakers in five countries: A discrete choice experiment eliciting relative preferences for equity and efficiency. Value Health. 2012;15:534–539.CrossRefGoogle ScholarPubMed
17.Youngkong, S, Kapiriri, L, Baltussen, R. Setting priorities for health interventions in developing countries: A review of empirical studies. Trop Med Int Health. 2009;14:930–939.CrossRefGoogle ScholarPubMed
18.Golan, O, Hansen, P, Kaplan, G, Tal, O. Health technology prioritization: Which criteria for prioritizing new technologies and what are their relative weights? Health Policy. 2011;102:126–135.CrossRefGoogle ScholarPubMed
19.Gibson, JL, Martin, DK, Singer, PA. Evidence, economics and ethics: Resource allocation in health services organizations. Healthc Q. 2005;8:50–59, 4.CrossRefGoogle ScholarPubMed
20.Djulbegovic, B, Trikalinos, TA, Roback, J, Chen, R, Guyatt, G. Impact of quality of evidence on the strength of recommendations: An empirical study. BMC Health Serv Res. 2009;9:120.CrossRefGoogle ScholarPubMed
21.Brozek, JL, Akl, EA, Alonso-Coello, P, et al.Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy. 2009;64:669–677.CrossRefGoogle ScholarPubMed
22.Evers, S, Goossens, M, de Vet, H, van Tulder, M, Ament, A. Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria. Int J Technol Assess Health Care. 2005;21:240–245.CrossRefGoogle ScholarPubMed
23.Saarni, SI, Hofmann, B, Lampe, K, et al.Ethical analysis to improve decision-making on health technologies. Bull World Health Organ. 2008;86:617–623.CrossRefGoogle ScholarPubMed
24.Burls, A, Caron, L, Cleret de Langavant, G, et al.Tackling ethical issues in health technology assessment: A proposed framework. Int J Technol Assess Health Care. 2011;27:230–237.CrossRefGoogle ScholarPubMed
25.Peacock, SJ, Mitton, C, Ruta, D, et al.Priority setting in healthcare: Towards guidelines for the program budgeting and marginal analysis framework. Expert Rev Pharmacoecon Outcomes Res. 2010;10:539–552.CrossRefGoogle ScholarPubMed
26.Dubois, RW, Graff, JS. Setting priorities for comparative effectiveness research: From assessing public health benefits to being open with the public. Health Aff (Millwood). 2011;30:2235–2242.CrossRefGoogle ScholarPubMed
27.Hyder, AA, Corluka, A, Winch, PJ, et al.National policy-makers speak out: Are researchers giving them what they need? Health Policy Plan. 2011;26:73–82.CrossRefGoogle ScholarPubMed