Exploring the perspectives and preferences for HTA across German healthcare stakeholders using a multi-criteria assessment of a pulmonary heart sensor as a case study

Abstract

BackgroundHealth technology assessment and healthcare decision-making are based on multiple criteria and evidence, and heterogeneous opinions of participating stakeholders. Multi-criteria decision analysis (MCDA) offers a potential framework to systematize this process and take different perspectives into account. The objectives of this study were to explore perspectives and preferences across German stakeholders when appraising healthcare interventions, using multi-criteria assessment of a heart pulmonary sensor as a case study.MethodsAn online survey of 100 German healthcare stakeholders was conducted using a comprehensive MCDA framework (EVIDEM V2.2). Participants were asked to provide i) relative weights for each criterion of the framework; ii) performance scores for a health pulmonary sensor, based on available data synthesized for each criterion; and iii) qualitative feedback on the consideration of contextual criteria. Normalized weights and scores were combined using a linear model to calculate a value estimate across different stakeholders. Differences across types of stakeholders were explored.ResultsThe survey was completed by 54 participants. The most important criteria were efficacy, patient reported outcomes, disease severity, safety, and quality of evidence (relative weight >0.075 each). Compared to all participants, policymakers gave more weight to budget impact and quality of evidence. The quantitative appraisal of a pulmonary heart sensor revealed differences in scoring performance of this intervention at the criteria level between stakeholder groups. The highest value estimate of the sensor reached 0.68 (on a scale of 0 to 1, 1 representing maximum value) for industry representatives and the lowest value of 0.40 was reported for policymakers, compared to 0.48 for all participants. Participants indicated that most qualitative criteria should be considered and their impact on the quantitative appraisal was captured transparently.ConclusionsThe study identified important variations in perspectives across German stakeholders when appraising a healthcare intervention and revealed that MCDA can demonstrate the value of a specified technology for all participating stakeholders. Better understanding of these differences at the criteria level, in particular between policymakers and industry representatives, is important to focus innovation aligned with patient health and healthcare system values and constraints.Electronic supplementary materialThe online version of this article (doi:10.1186/s12961-015-0011-1) contains supplementary material, which is available to authorized users.

Exploring Perspectives and Preferences for Over-Diagnosis and Overtreatment of Thyroid Nodules using a MCDA Method

“…Participants in this study indicated that the most important criteria were 'Comparative effectiveness', 'Type of therapeutic bene t', 'Disease severity', 'Comparative patients' perceived health', 'Comparative safety' and 'Unmet needs'. These results are similar to the results of a survey for the topic of chronic heart disease of all types of stakeholders across the healthcare decision continuum in Germany, which indicated the most important criteria were 'Clinical effectiveness', 'Patients' perceived health', 'Disease severity', 'Clinical safety' and 'Quality of evidence' [21].…”

“…This difference truly highlights the need for effective communication between physicians and patients, which helps patients to express their need and incorporate their individual priorities in patients-centered healthcare system. Referring to 'Economic consequence of intervention', all participants assigned lower values than other criteria, this showed the same in another MCDA study under German healthcare system [21]. These results are in agreement with health professionals, they wish to help patients without focusing on economic constrains [21,22].…”

“…Most of them recruited a group of people to make a focus group to do interview face to face [17][18][19][20]. Our study used an on-line platform to involve more participants [21]. Recruitment of more participants can avoid being in uenced by others, such as people in a focus group.…”

Healthcare decision‐making applications using multicriteria decision analysis: A scoping review

“…Stakeholders were invited to participate in the problem structuring phase to define the criteria. When data was collected through surveys (Wagner et al, ; Wahlster, Goetghebeur, Schaller, Kriza, & Kolominsky‐Rabas, ; Mobinizadeh, Raeissi, Nasiripour, Olyaeemanesh, & Tabibi, ; Poulin et al, ), the number of participants (when available) was relatively significant (11, 30, and 54). One study (Wanishayakorn and Ngorsuraches, ) interviewed three stakeholders to gather their respective viewpoints.…”

“…Findings from MCDA applications can be used to support choices (Hummel et al, ) or reinforce existing ones (Laufer, ) by clarifying (Koch & Rowell, ) and improving (Hummel et al, ) decision‐making processes. However, one study (Wahlster, Goetghebeur, Schaller, et al, ) noted that MCDA should be considered a helping tool, and not a formula, to guide stakeholders while making and accepting decisions.…”