Anderson Pippa, Webb Philip, Groves Sam
Swansea Centre for Health Economics, Swansea University, Singleton Park, Swansea SA2 8PP, UK.
Velindre NHS Trust Velindre NHS Trust, Corporate Headquarters: Unit 2, Charnwood Court, Parc Nantgarw, Nantgarw, Cardiff CF15 7QZ, UK.
Health Policy. 2017 Sep;121(9):978-985. doi: 10.1016/j.healthpol.2017.06.007. Epub 2017 Jun 24.
The challenges of delivering healthcare within budget constraints are ever present. Highly specialised technologies (HSTs) have high costs of provision inevitably contributing to NHS cost pressures. Between 2012-2015 the Welsh Health Specialised Services Committee (WHSSC) developed prioritisation methods to make recommendations for HST funding in Wales. Methods adapted as the process continued but was always evidence based and supported by a prioritisation panel of stakeholders. Methods changed from discreet choice to the Portsmouth Score Card, a simple multi-criteria decision analysis (MCDA) method. A strength of MCDA is that the impact on a decision of relevant criteria and their relative importance is explicit. This was, later, augmented by group decision support techniques. The prioritisation panel workload was on average eight HST condition treatment pairs in each l meeting, covering 133 HSTs over 3 years. Available evidence, information and value judgements were used to make decisions. The WHSSC framework identifies investment, dis-investment and recommendations transparently. The 'real-world' need for timely decisions was met, in the absence of National Institute for Health and Care Excellence (NICE) guidance on HSTs (initiated 2013, covering only drugs). In mid-2015 the prioritisation process was benchmarked against the EVIDEM framework, identifying areas of best practice and improvement: need for greater public and patient engagement. Some implementation issues for decisions based on panel recommendations remain to be resolved.
在预算限制内提供医疗保健的挑战一直存在。高度专业化技术（HSTs）的提供成本高昂，不可避免地给英国国家医疗服务体系（NHS）带来成本压力。2012年至2015年期间，威尔士健康专业化服务委员会（WHSSC）制定了优先排序方法，为威尔士的HST资金提供建议。随着进程的持续，方法不断调整，但始终以证据为基础，并得到利益相关者优先排序小组的支持。方法从离散选择转变为朴茨茅斯计分卡，这是一种简单的多标准决策分析（MCDA）方法。MCDA的一个优点是，相关标准对决策的影响及其相对重要性是明确的。后来，这又通过群体决策支持技术得到了加强。优先排序小组的工作量平均为每次会议八个HST病症治疗组合，在三年时间里涵盖了133种HSTs。利用现有证据、信息和价值判断来做出决策。WHSSC框架透明地确定投资、撤资和建议。在缺乏国家卫生与保健优化研究所（NICE）关于HSTs的指南（2013年启动，仅涵盖药物）的情况下，满足了对及时决策的“现实世界”需求。2015年年中，优先排序过程以EVIDEM框架为基准进行评估，确定了最佳实践和改进领域：需要加强公众和患者的参与。基于小组建议的决策的一些实施问题仍有待解决。
