Articlegold2010

Combining multicriteria decision analysis, ethics and health technology assessment: applying the EVIDEM decisionmaking framework to growth hormone for Turner syndrome patients

Mireille M. Goetghebeur · Monika Wagner · Donna Rindress · Jean‐Pierre Grégoire · Cheri Deal

105 citations0/0 files storedCost Effectiveness and Resource Allocation

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Health Systems, Economic Evaluations, Quality of Life Multi-Criteria Decision Making Delphi Technique in Research

Abstract

OBJECTIVES: To test and further develop a healthcare policy and clinical decision support framework using growth hormone (GH) for Turner syndrome (TS) as a complex case study. METHODS: The EVIDEM framework was further developed to complement the multicriteria decision analysis (MCDA) Value Matrix, that includes 15 quantifiable components of decision clustered in four domains (quality of evidence, disease, intervention and economics), with a qualitative tool including six ethical and health system-related components of decision. An extensive review of the literature was performed to develop a health technology assessment report (HTA) tailored to each component of decision, and content was validated by experts. A panel of representative stakeholders then estimated the MCDA value of GH for TS in Canada by assigning weights and scores to each MCDA component of decision and then considered the impact of non-quantifiable components of decision. RESULTS: Applying the framework revealed significant data gaps and the importance of aligning research questions with data needs to truly inform decision. Panelists estimated the value of GH for TS at 41% of maximum value on the MCDA scale, with good agreement at the individual level (retest value 40%; ICC: 0.687) and large variation across panelists. Main contributors to this panel specific value were "Improvement of efficacy", "Disease severity" and "Quality of evidence". Ethical considerations on utility, efficiency and fairness as well as potential misuse of GH had mixed effects on the perceived value of the treatment. CONCLUSIONS: This framework is proposed as a pragmatic step beyond the current cost-effectiveness model, combining HTA, MCDA, values and ethics. It supports systematic consideration of all components of decision and available evidence for greater transparency. Further testing and validation is needed to build up MCDA approaches combined with pragmatic HTA in healthcare decision-making.

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References

1979Intraclass correlations: Uses in assessing rater reliability.2006Priority setting of health interventions: the need for multi-criteria decision analysis.2008Key principles for the improved conduct of health technology assessments for resource allocation decisions 2009Priority setting: what constitutes success? A conceptual framework for successful priority setting 2008Evidence and Value: Impact on DEcisionMaking – the EVIDEM framework and potential applications 2009QALYs: Some Challenges 2006Towards a multi‐criteria approach for priority setting: an application to Ghana 2005Toward a procedure for integrating moral issues in health technology assessment

Cited by

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