Bridging health technology assessment (HTA) with multicriteria decision analyses (MCDA): field testing of the EVIDEM framework for coverage decisions by a public payer in Canada.
Bridging health technology assessment (HTA) with multicriteria decision analyses (MCDA): field testing of the EVIDEM framework for coverage decisions by a public payer in Canada.
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DOI：
10.1186/1472-6963-11-329
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发表时间：
2011-11-30
影响因子：
2.8
通讯作者：
Goetghebeur MM
中科院分区：
文献类型：
--
作者：
Tony M;Wagner M;Khoury H;Rindress D;Papastavros T;Oh P;Goetghebeur MM
一致的医疗保健决策需要系统地考虑决策标准和可获得的证据。这可以通过结合多标准决策分析（MCDA）和卫生技术评估（HTA）来解决。本研究的目的是实地测试决策支持框架（EVIDEM），探索其对药物咨询委员会的效用，并随着时间的推移测试其可靠性。曲马多治疗慢性非癌性疼痛被健康计划选择作为与其背景相关的案例研究。在广泛的文献回顾的基础上，开发了一份按标准的HTA报告，为框架的每个标准（MCDA核心模型的14个标准和上下文工具的6个定性标准）提供综合证据。在研讨会期间，委员会成员通过分配三个步骤来测试框架：1)对代表个人观点的MCDA核心模型的每个标准赋予权重；2)曲马多对MCDA核心模型各指标的综合评分；3)上下文工具的标准对评估的定性影响。通过讨论、调研和复试，探讨了该方法的实用性和可靠性。通过计算权重、分数和MCDA值估计值的加权相关系数（ICCs）来分析测试和重测数据之间的一致性。药物咨询委员会认为，该框架有助于支持系统地考虑广泛的标准，以促进一致的方法来评估医疗保健干预措施。作为“按标准”的卫生评价报告直接纳入框架，每个标准的综合证据有助于对其进行审议，尽管有时由于缺乏相关数据而受到限制。测试-重测试分析显示，在个体水平（ICC范围从0.676到0.698）上，权重、分数和MCDA值估计具有相当好的一致性，从而为该方法的可靠性提供了一些支持。总的来说，委员会成员赞同列入大多数框架标准，并揭示了讨论、澄清和使框架适应委员会需要的重要领域。通过促进对所有决策标准和潜在证据的系统考虑，该框架允许采用一致的方法来评估卫生保健干预措施。需要进一步的测试和验证来推进MCDA方法在医疗保健决策中的应用。
Consistent healthcare decisionmaking requires systematic consideration of decision criteria and evidence available to inform them. This can be tackled by combining multicriteria decision analysis (MCDA) and Health Technology Assessment (HTA). The objective of this study was to field-test a decision support framework (EVIDEM), explore its utility to a drug advisory committee and test its reliability over time. Tramadol for chronic non-cancer pain was selected by the health plan as a case study relevant to their context. Based on extensive literature review, a by-criterion HTA report was developed to provide synthesized evidence for each criterion of the framework (14 criteria for the MCDA Core Model and 6 qualitative criteria for the Contextual Tool). During workshop sessions, committee members tested the framework in three steps by assigning: 1) weights to each criterion of the MCDA Core Model representing individual perspective; 2) scores for tramadol for each criterion of the MCDA Core Model using synthesized data; and 3) qualitative impacts of criteria of the Contextual Tool on the appraisal. Utility and reliability of the approach were explored through discussion, survey and test-retest. Agreement between test and retest data was analyzed by calculating intra-rater correlation coefficients (ICCs) for weights, scores and MCDA value estimates. The framework was found useful by the drug advisory committee in supporting systematic consideration of a broad range of criteria to promote a consistent approach to appraising healthcare interventions. Directly integrated in the framework as a "by-criterion" HTA report, synthesized evidence for each criterion facilitated its consideration, although this was sometimes limited by lack of relevant data. Test-retest analysis showed fair to good consistency of weights, scores and MCDA value estimates at the individual level (ICC ranging from 0.676 to 0.698), thus lending some support for the reliability of the approach. Overall, committee members endorsed the inclusion of most framework criteria and revealed important areas of discussion, clarification and adaptation of the framework to the needs of the committee. By promoting systematic consideration of all decision criteria and the underlying evidence, the framework allows a consistent approach to appraising healthcare interventions. Further testing and validation are needed to advance MCDA approaches in healthcare decisionmaking.
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DOI：
10.2165/11539470-000000000-00000
发表时间：
2010
期刊：
The patient
影响因子：
--
作者：
Dolan JG
通讯作者：
Dolan JG
影响因子：
2.6
作者：
Cicero, TJ;Inciardi, JA;Mu単oz, A
通讯作者：
Mu単oz, A
DOI：
10.1186/1478-7547-4-14
发表时间：
2006-08-21
期刊：
Cost effectiveness and resource allocation : C/E
影响因子：
--
作者：
Baltussen R;Niessen L
通讯作者：
Niessen L
影响因子：
7.4
作者：
Cicero, Theodore J.;Wong, Gordon;Isenberg, Keith
通讯作者：
Isenberg, Keith
影响因子：
2.2
作者：
Daniels, N;Sabin, J
通讯作者：
Sabin, J