Implementing evidence-informed deliberative processes in health technology assessment: a low income country perspective

Kapiriri, Lydia; Baltussen, Rob; Oortwijn, Wija

doi:10.1017/s0266462319003398

Cited by 17 publications

(17 citation statements)

References 16 publications

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“…The overall concept of EDPs stems from the general principle of legitimacy, the definition of four elements is a practical translation of the Accountability for Reasonableness framework, 5 the definition of practical steps is based on existing HTA methods and tools, whereas related recommendations on best practices are inferred from observed practices of HTA bodies around the world. The development process itself was geared through academic knowledge exchange 15,[18][19][20][21][22][23][24][25][26][27][28] and the experience of implementing EDPs in several countries. We also surveyed HTA bodies and experts around the globe on their need for guidance.…”

Section: Development Of Practical Guidancementioning

confidence: 99%

Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide

Oortwijn¹,

Jansen²,

Baltussen³

2021

Int J Health Policy Manag

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Background. Countries around the world are using health technology assessment (HTA) for health benefit package design. Evidence-informed deliberative processes (EDPs) are a practical and stepwise approach to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. This paper reports on the development of practical guidance on EDPs, while the conceptual framework of EDPs is described in a companion paper. Methods. The first guide on EDPs (2019) is further developed based on academic knowledge exchange, surveying 27 HTA bodies and 66 experts around the globe, and the implementation of EDPs in several countries. We present the revised steps of EDPs and how selected HTA bodies (in Australia, Brazil, Canada, France, Germany, Scotland, Thailand and the United Kingdom) organize key issues of legitimacy in their processes. This is based on a review of literature via PubMed and HTA bodies’ websites. Results. HTA bodies around the globe vary considerable in how they address legitimacy (stakeholder involvement ideally through participation with deliberation; evidence-informed evaluation; transparency; and appeal) in their processes. While there is increased attention for improving legitimacy in decision-making processes, we found that the selected HTA bodies are still lacking or just starting to develop activities in this area. We provide recommendations on how HTA bodies can improve on this. Conclusion. The design and implementation of EDPs is in its infancy. We call for a systematic analysis of experiences of a variety of countries, from which general principles on EDPs might subsequently be inferred.

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Section: Development Of Practical Guidancementioning

confidence: 99%

Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide

Oortwijn¹,

Jansen²,

Baltussen³

2021

Int J Health Policy Manag

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“…Given the increasing interest and focusin this journal and beyondon both deliberation in MCDA (26)(27)(28) and how deliberation can and should be used to inform HTA more generally (29), this commentary provides further insights and arguments to guide ongoing experimentation and evaluation of different deliberative approaches for health priority-setting on the bases of quality, transparency, and other important goals of decision making. To this end, we propose that it may be more constructive to move away from a typology that distinguishes MCDA in terms of quantitative and qualitative assessment and instead focus on how well different deliberative, multi-criteria approaches are able to incorporate and balance the various types of qualitative and quantitative informational inputs that are morally relevant to the decisions at hand.…”

Section: Resultsmentioning

confidence: 99%

Beyond the numbers: a critique of quantitative multi-criteria decision analysis

DiStefano

Krubiner

2020

Int J Technol Assess Health Care

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When setting priorities for health, there is broad agreement that a range of social values and ethical principles beyond clinical and cost-effectiveness matter, but exactly how health technology assessment (HTA) should account for a broader set of criteria remains an area of ongoing debate. In light of this, we welcome a recent review paper by Baltussen et al. evaluating the potential of different multi-criteria decision analysis (MCDA) approaches to enable HTA agencies to incorporate a broader set of values in their appraisals. The authors describe three approaches to MCDA—qualitative MCDA, quantitative MCDA, and MCDA with decision rules—laying out their relative advantages and disadvantages and providing recommendations for how they can best be implemented. While we endorse many of the authors' assessments and conclusions, including the critical role of deliberation in any MCDA approach and the undertaking of qualitative MCDA at a minimum, we take a stronger position regarding the flaws of quantitative MCDA and strongly caution against it. We find quantitative MCDA antithetical to at least two of the ways MCDA is intended to improve HTA recommendations: (i) enhancing quality and (ii) promoting transparency. Quantitative MCDA may mask the complex tradeoffs that exist within and between decision criteria and remain generally inaccessible to those who are not well-versed in its technical methods of appraisal. We advocate for a predominantly qualitative approach to MCDA appraisal centered around deliberation and supplemented with decision aids to help account for health opportunity costs.

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“…The lesson that we learned from this survey is that EDPs have the potential to provide the necessary steps for legitimate decision making using HTA in LMIC. As we have recently argued in a commentary on the potential use of EDPs for low-income countries, successful implementation of EDPs in HTA would be augmented by considering how to deal with the lack of transparency and participation culture in some contexts, and by providing additional guidance on how to set up HTA organizations, especially for countries that lack designated HTA organizations (10). For this reason, monitoring and evaluation of implementing EDPs in different contexts are of utmost importance.…”

Section: Discussionmentioning

confidence: 99%

Application of evidence-informed deliberative processes in health technology assessment in low- and middle-income countries

Oortwijn

Oosterhout

Kapiriri

2020

Int J Technol Assess Health Care

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Objectives Evidence-informed deliberative processes (EDPs) were introduced to guide health technology assessment (HTA) agencies to improve their processes toward more legitimate decision making. A survey among members of the International Network of Agencies for HTA (INAHTA) showed that EDPs can also be relevant for countries that have not (yet) established such an agency. Therefore, we explored to what extent low- and middle-income countries (LMIC) applied the steps and elements stipulated in the EDP framework and their need for guidance. Methods The survey among INAHTA members was slightly adapted to address LMIC context and sent to 416 experts identified through several HTA sources. The questions focused on contextual factors and the EDP steps (installation of an appraisal committee, selecting technologies and criteria, assessment, appraisal, communication and appeal). Data collection took place between 21 May and 1 September 2019. Descriptive statistics and qualitative analyses were used to summarize the findings. Results We received sixty-six meaningful responses from experts in thirty-two LMIC. We found that contextual factors to support HTA development are overall not present or only present to some extent. Respondents indicated that guidance was needed for specific elements related to selecting technologies and criteria, assessment, appraisal, as well as communication and appeal. Conclusions EDPs have the potential to provide steps for improving HTA processes. The results of this study can serve as a baseline measurement for future monitoring and evaluation of EDP application in the responding LMIC. This could support the countries in improving their processes and enhancing legitimate decision making when using HTA.

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Implementing evidence-informed deliberative processes in health technology assessment: a low income country perspective

Cited by 17 publications

References 16 publications

Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide

Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide

Beyond the numbers: a critique of quantitative multi-criteria decision analysis

Application of evidence-informed deliberative processes in health technology assessment in low- and middle-income countries

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