School of Public Health, University of Alberta, Edmonton, AB, Canada.
Pharmacoeconomics. 2011 Sep;29(9):771-80. doi: 10.2165/11539840-000000000-00000.
Attempts to improve the acceptability of resource allocation decisions around new health technologies have spanned many years, fields and disciplines. Various theories of decision making have been tested and methods piloted, but, despite their availability, evidence of sustained uptake is limited. Since the challenge of determining which of many technologies to fund is one that healthcare systems have faced since their inception, an analysis of actual processes, criticisms confronted and approaches used to manage them may serve to guide the development of an 'evidence-informed' decision-making framework for improving the acceptability of decisions.
The purpose of this study was to develop a technology funding decision-making framework informed by the experiences of multiple healthcare systems and the views of senior-level decision makers in Canada.
A 1-day, facilitated workshop was held with 16 senior-level healthcare decision makers in Canada. International examples of actual technology funding decision-making processes were presented. Participants discussed key elements of these processes, debated strengths and weaknesses and highlighted unresolved challenges. The findings were used to construct a technology decision-making framework on which participant feedback was then sought. Its relevance, content, structure and feasibility were further assessed through key informant interviews with ten additional senior-level decision makers.
Six main issues surrounding current processes were raised: (i) timeliness; (ii) methodological considerations; (iii) interpretations of 'value for money'; (iv) explication of social values; (v) stakeholder engagement; and (vi) 'accountability for reasonableness'. While no attempt was made to force consensus on what should constitute each of these, there was widespread agreement on questions that must be addressed through a 'robust' process. These questions, grouped and ordered into three phases, became the final framework.
A decision-making framework informed by processes in other jurisdictions and the views of local decision makers was developed. Pilot testing underway in one Canadian jurisdiction will identify any further refinements needed to optimize its usefulness.
多年来，人们尝试改进针对新医疗技术的资源分配决策的可接受性，涵盖了多个领域和学科。各种决策理论已经过测试和方法试点，但尽管已经有了这些方法，其可持续采用的证据仍然有限。由于确定应资助众多技术中的哪项技术是医疗保健系统自成立以来一直面临的挑战，因此对实际流程、面临的批评和用于管理这些流程的方法进行分析，可能有助于指导制定一个“基于证据”的决策框架，以提高决策的可接受性。
本研究旨在制定一个受多个医疗保健系统的经验和加拿大高级别决策者意见启发的技术资金决策框架。
在加拿大举行了为期一天的、有主持人引导的研讨会，有 16 名高级别医疗保健决策者参加。介绍了国际上实际的技术资金决策过程的例子。与会者讨论了这些过程的关键要素，对其优缺点进行了辩论，并强调了未解决的挑战。根据这些发现，构建了一个技术决策框架，并征求了与会者的反馈意见。然后通过对另外 10 名高级别决策者进行关键知情人访谈，进一步评估了其相关性、内容、结构和可行性。
提出了当前流程中存在的六个主要问题：（i）及时性；（ii）方法学考虑；（iii）“物有所值”的解释；（iv）社会价值的阐明；（v）利益相关者的参与；以及（vi）“合理性的问责制”。虽然没有试图就这些问题中的每一个应该包含什么达成共识，但对于必须通过“稳健”流程来解决的问题，广泛达成了一致。这些问题被分组并按三个阶段进行排序，最终成为该框架。
制定了一个受其他司法管辖区的流程和当地决策者意见启发的决策框架。正在一个加拿大司法管辖区进行试点测试，以确定进一步优化其有用性所需的任何改进。
