Which Criteria Are Considered in Healthcare Decisions? Insights From an International Survey of Policy and Clinical Decision Makers

Tanios, Nataly; Wagner, Monika; Tony, Michèle; Baltussen, Rob; Til, Janine Astrid van; Rindress, Donna; Kind, Paul; Goetghebeur, Mireille

doi:10.1017/s0266462313000573

Cited by 91 publications

(84 citation statements)

References 30 publications

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“…[43, 46] Consideration of disease severity is rooted in distributive justice and fairness [26] and rank high in each country. It also revealed the predominance of the “imperative to help, an aspect of deontology including beneficence and non-maleficence” embedded in criteria “Effectiveness”, “Safety” and “Type of benefit”, which ranked among the highest weights.…”

Section: Discussionmentioning

confidence: 99%

Appraising the holistic value of Lenvatinib for radio-iodine refractory differentiated thyroid cancer: A multi-country study applying pragmatic MCDA

Wagner¹,

Khoury²,

Bennetts³

et al. 2017

BMC Cancer

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BackgroundThe objective of the study was to reveal through pragmatic MCDA (EVIDEM) the contribution of a broad range of criteria to the value of the orphan drug lenvatinib for radioiodine refractory differentiated thyroid cancer (RR-DTC) in country-specific contexts.MethodsThe study was designed to enable comprehensive appraisal (12 quantitative, 7 qualitative criteria) in the current disease context (watchful waiting, sorafenib) of France, Italy and Spain. Data on the value of lenvatinib was collected from diverse stakeholders during country-specific panels and included: criteria weights (individual and social values); performance scores (judgments on evidence—collected through MCDA systematic review); qualitative impacts of contextual criteria; and verbal and written insights structured by criteria. The value contribution of each criterion was calculated and uncertainty explored.Results Comparative effectiveness, Quality of evidence (Spain and Italy) and Disease severity (France) received the greatest weights. Four criteria contributed most to the value of lenvatinib, reflecting its superior Comparative effectiveness (16–22% of value), the severity of RR-DTC (16–22%), significant unmet needs (14–21%) and robust evidence (14–20%). Contributions varied by comparator, country and individuals, highlighting the importance of context and consultation. Results were reproducible at the group level. Impacts of contextual criteria varied across countries reflecting different health systems and cultural backgrounds. The MCDA process promoted sharing stakeholders’ knowledge on lenvatinib and insights on context.ConclusionsThe value of lenvatinib was consistently positive across diverse therapeutic contexts. MCDA identified the aspects contributing most to value, revealed rich contextual insights, and helped participants express and explicitly tackle ethical trade-offs inherent to balanced appraisal and decisionmaking.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3258-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Appraising the holistic value of Lenvatinib for radio-iodine refractory differentiated thyroid cancer: A multi-country study applying pragmatic MCDA

Wagner¹,

Khoury²,

Bennetts³

et al. 2017

BMC Cancer

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“…Decisions are made at macro (national, state/provincial and regional), meso (institutional) and micro (individual) levels [22]. Each sector of the health system has a decision-making infrastructure within which individuals or groups make decisions on behalf of the jurisdiction or individual facility.…”

Section: Introductionmentioning

confidence: 99%

Sustainability in health care by allocating resources effectively (SHARE) 3: examining how resource allocation decisions are made, implemented and evaluated in a local healthcare setting

Harris

Allen

Waller

et al. 2017

BMC Health Serv Res

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BackgroundThis is the third in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Leaders in a large Australian health service planned to establish an organisation-wide, systematic, integrated, evidence-based approach to disinvestment. In order to introduce new systems and processes for disinvestment into existing decision-making infrastructure, we aimed to understand where, how and by whom resource allocation decisions were made, implemented and evaluated. We also sought the knowledge and experience of staff regarding previous disinvestment activities.MethodsStructured interviews, workshops and document analysis were used to collect information from multiple sources in an environmental scan of decision-making systems and processes. Findings were synthesised using a theoretical framework.ResultsSixty-eight respondents participated in interviews and workshops. Eight components in the process of resource allocation were identified: Governance, Administration, Stakeholder engagement, Resources, Decision-making, Implementation, Evaluation and, where appropriate, Reinvestment of savings. Elements of structure and practice for each component are described and a new framework was developed to capture the relationships between them. A range of decision-makers, decision-making settings, type and scope of decisions, criteria used, and strengths, weaknesses, barriers and enablers are outlined. The term ‘disinvestment’ was not used in health service decision-making. Previous projects that involved removal, reduction or restriction of current practices were driven by quality and safety issues, evidence-based practice or a need to find resource savings and not by initiatives where the primary aim was to disinvest. Measuring resource savings is difficult, in some situations impossible. Savings are often only theoretical as resources released may be utilised immediately by patients waiting for beds, clinic appointments or surgery. Decision-making systems and processes for resource allocation are more complex than assumed in previous studies.ConclusionThere is a wide range of decision-makers, settings, scope and type of decisions, and criteria used for allocating resources within a single institution. To our knowledge, this is the first paper to report this level of detail and to introduce eight components of the resource allocation process identified within a local health service.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2207-2) contains supplementary material, which is available to authorized users.

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“…Second, expanding the remit of other HTA bodies to include environmental impacts would be consistent with the opinion of healthcare decision makers who have expressed their interest in maximizing a broader set of social welfare benefits, including environmental outcomes Figure 1. Model logic for the environmental adaptation to the health economic model (9). Third, environmental impacts can interfere with a decisionmaker's objective to maximize population health (10)(11)(12)(13).…”

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confidence: 99%

Incorporating Environmental Outcomes Into a Health Economic Model

Marsh¹,

Ganz

Nørtoft

et al. 2016

Int J Technol Assess Health Care

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Objectives: Traditional economic evaluations for most health technology assessments (HTAs) have previously not included environmental outcomes. With the growing interest in reducing the environmental impact of human activities, the need to consider how to include environmental outcomes into HTAs has increased. We present a simple method of doing so. Methods: We adapted an existing clinical-economic model to include environmental outcomes (carbon dioxide [CO 2 ] emissions) to predict the consequences of adding insulin to an oral antidiabetic (OAD) regimen for patients with type 2 diabetes mellitus (T2DM) over 30 years, from the United Kingdom payer perspective. Epidemiological, efficacy, healthcare costs, utility, and carbon emissions data were derived from published literature. A scenario analysis was performed to explore the impact of parameter uncertainty.Results: The addition of insulin to an OAD regimen increases costs by 2,668 British pounds per patient and is associated with 0.36 additional quality-adjusted life-years per patient. The insulin-OAD combination regimen generates more treatment and disease management-related CO 2 emissions per patient (1,686 kg) than the OAD-only regimen (310 kg), but generates fewer emissions associated with treating complications (3,019 kg versus 3,337 kg). Overall, adding insulin to OAD therapy generates an extra 1,057 kg of CO 2 emissions per patient over 30 years. Conclusions: The model offers a simple approach for incorporating environmental outcomes into health economic analyses, to support a decision-maker's objective of reducing the environmental impact of health care. Further work is required to improve the accuracy of the approach; in particular, the generation of resource-specific environmental impacts.

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Which Criteria Are Considered in Healthcare Decisions? Insights From an International Survey of Policy and Clinical Decision Makers

Abstract: 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.

Cited by 91 publications

References 30 publications

Appraising the holistic value of Lenvatinib for radio-iodine refractory differentiated thyroid cancer: A multi-country study applying pragmatic MCDA

Appraising the holistic value of Lenvatinib for radio-iodine refractory differentiated thyroid cancer: A multi-country study applying pragmatic MCDA

Sustainability in health care by allocating resources effectively (SHARE) 3: examining how resource allocation decisions are made, implemented and evaluated in a local healthcare setting

Incorporating Environmental Outcomes Into a Health Economic Model

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