Bridging Health Technology Assessment (HTA) and Efficient Health Care Decision Making with Multicriteria Decision Analysis (MCDA): Applying the EVIDEM Framework to Medicines Appraisal
Bridging Health Technology Assessment (HTA) and Efficient Health Care Decision Making with Multicriteria Decision Analysis (MCDA): Applying the EVIDEM Framework to Medicines Appraisal
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DOI：
10.1177/0272989x11416870
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发表时间：
2012-03-01
影响因子：
3.6
通讯作者：
Rindress, Donna
中科院分区：
文献类型：
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作者：
Goetghebeur, Mireille M.;Wagner, Monika;Rindress, Donna
背景卫生保健决策是复杂的，需要高效和明确的流程，以确保所考虑因素的透明度和一致性。目标.试行一个适应性强的决策框架，将多标准决策分析纳入卫生技术评估，由一个泛加拿大的政策和临床决策者和研究人员小组对涵盖6个治疗领域的10种药物进行评估。方法.召集了一个评估小组，要求参与者表达他们的个人观点，独立于药物，通过为MCDA核心模型的每个标准分配权重：疾病严重程度，人口规模，当前实践和未满足的需求，干预结果（疗效，安全性，患者报告），健康益处类型，经济学和证据质量。然后，参与者使用涵盖MCDA CORE模型标准的“按标准”HTA报告中合成的现有证据为每种药物分配性能评分。MCDA估计的感知价值计算结合归一化的权重和分数。通过有条理的讨论收集了对这一办法的反馈意见。结果标准的相对权重差别很大，反映了参与者的不同观点。每个标准的分数提供了一个性能指标，突出了每种药物的优势和劣势。MCDA对各种药物的感知价值的估计值从0.42到0.64不等，提供了包含一系列标准的综合衡量标准。与会者报告说，该框架提供了一种有效的办法，以务实的方式系统地审议指导决策的多个要素，包括标准和价值观（军事和民防资源核心模式）和证据（卫生技术评估“按标准”报告）。结论.这项概念验证研究表明，将军事和民防资源纳入卫生技术评估有助于支持对卫生保健干预措施进行透明和系统的评估。需要进一步的研究来推进基于MCDA的方法，以更有效地做出医疗保健决策。
Background. Health care decision making is complex and requires efficient and explicit processes to ensure transparency and consistency of factors considered. Objectives. To pilot an adaptable decision-making framework incorporating multicriteria decision analysis (MCDA) in health technology assessment (HTA) with a pan-Canadian group of policy and clinical decision makers and researchers appraising 10 medicines covering 6 therapeutic areas. Methods. An appraisal group was convened and participants were asked to express their individual perspectives, independently of the medicines, by assigning weights to each criterion of the MCDA core model: disease severity, size of population, current practice and unmet needs, intervention outcomes (efficacy, safety, patient reported), type of health benefit, economics, and quality of evidence. Participants then assigned performance scores for each medicine using available evidence synthesized in a "by-criterion" HTA report covering each of the MCDA CORE model criteria. MCDA estimates of perceived value were calculated by combining normalized weights and scores. Feedback on the approach was collected through structured discussion. Results. Relative weights on criteria varied widely, reflecting the diverse perspectives of participants. Scores for each criterion provided a performance measure, highlighting strengths and weaknesses of each medicine. MCDA estimates of perceived value ranged from 0.42 to 0.64 across medicines, providing comprehensive measures incorporating a large spectrum of criteria. Participants reported that the framework provided an efficient approach to systematic consideration in a pragmatic format of the multiple elements guiding decision, including criteria and values (MCDA core model) and evidence (HTA "by-criterion" report). Conclusions. This proof-of-concept study demonstrated the usefulness of incorporating MCDA in HTA to support transparent and systematic appraisal of health care interventions. Further research is needed to advance MCDA-based approaches to more effective healthcare decision making.