Strømme Elisabeth Marie, Baerøe Kristine, Norheim Ole Frithjof
Dev World Bioeth. 2014 Dec;14(3):132-41. doi: 10.1111/dewb.12016. Epub 2013 May 31.
In the context of limited health care budgets in countries where Neglected Tropical Diseases (NTDs) are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities.
The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making matrix, and 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context.
This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases.
Our in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise.
By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised.
在被忽视热带病（NTDs）流行的国家，卫生保健预算有限，扩大疾病控制干预措施需要确定优先事项。然而，仅基于成本效益分析的解决方案可能导致有偏差且理由不充分的优先事项。
本文的目标是：1）展示如何利用一系列公平性考量来确定可行的优先事项设定标准；2）说明如何将这些标准纳入多标准决策矩阵；3）讨论在现实世界决策背景下应在何种条件下进行这一决策程序。
本文借鉴了决策分析理论和公平资源分配伦理理论的要素。我们采用了一种经过修改的多标准决策分析模型，该模型带有从世界卫生组织正在制定的优先事项设定指南中提取的预定义标准，对六种典型的NTD干预措施进行了探索。为了确定这六种选定干预措施的相关证据，我们检索了PubMed和Cochrane数据库。
我们的体外多标准决策分析表明，内脏利什曼病的病例管理应比预防土壤传播蠕虫感染的大规模运动获得更高的优先级。这似乎与当前的卫生保健优先事项以及文献中的建议相矛盾。我们还考虑了情境化决策过程中应满足的程序条件，并强调了本研究的局限性。
通过探索如何同时考虑与NTDs多方面特征相关的几个标准，我们能够提出如何在NTDs中实现更好的优先事项设定。
