Toronto General Hospital Research Institute, Toronto Health Economics and Technology Assessment Collaborative (THETA)
University of Toronto, Institute of Health Policy, Management and Evaluation.
Int J Technol Assess Health Care. 2018 Jun;34(3):290-299. doi: 10.1017/S0266462318000235.
In 2007, the Ontario Health Technology Advisory Committee (OHTAC) developed a decision framework to guide decision making around nondrug health technologies. In 2012, OHTAC commissioned a revision of this framework to enhance its usability and deepen its conceptual and theoretical foundations.
The committee overseeing this work used several methods: (a) a priori consensus on guiding principles, (b) a scoping review of decision attributes and processes used globally in health technology assessment (HTA), (c) presentations by methods experts and members of review committees, and (d) committee deliberations over a period of 3 years.
The committee adopted a multi-criteria decision-making approach, but rejected the formal use of multi-criteria decision analysis. Three broad categories of attributes were identified: (I) context criteria attributes included factors such as stakeholders, adoption pressures from neighboring jurisdictions, and potential conflicts of interest; (II) primary appraisal criteria attributes included (i) benefits and harms, (ii) economics, and (iii) patient-centered care; (III) feasibility criteria attributes included budget impact and organizational feasibility.
The revised Ontario Decision Framework is similar in some respects to frameworks used in HTA worldwide. Its distinctive characteristics are that: it is based on an explicit set of social values; HTA paradigms (evidence based medicine, economics, and bioethics/social science) are used to aggregate decision attributes; and that it is rooted in a theoretical framework of optimal decision making, rather than one related to broad social goals, such as health or welfare maximization.
2007 年，安大略省卫生技术咨询委员会（OHTAC）制定了一个决策框架，以指导非药物卫生技术的决策。2012 年，OHTAC 委托对该框架进行修订，以提高其可用性，并深化其概念和理论基础。
负责这项工作的委员会使用了几种方法：（a）对指导原则达成事先共识，（b）对全球卫生技术评估（HTA）中使用的决策属性和流程进行范围审查，（c）方法专家和审查委员会成员的介绍，以及（d）委员会在 3 年期间进行的审议。
委员会采用了多准则决策方法，但拒绝正式使用多准则决策分析。确定了三类广泛的属性：（I）背景标准属性，包括利益相关者、来自邻近司法管辖区的采用压力以及潜在的利益冲突等因素；（II）主要评估标准属性，包括（i）收益和危害、（ii）经济学和（iii）以患者为中心的护理；（III）可行性标准属性，包括预算影响和组织可行性。
修订后的安大略决策框架在某些方面与全球 HTA 中使用的框架相似。其独特特点是：它基于一套明确的社会价值观；HTA 范式（循证医学、经济学和生物伦理学/社会科学）用于汇总决策属性；并且它植根于最佳决策的理论框架，而不是与广泛的社会目标（如健康或福利最大化）相关的框架。
