Stratil J M, Baltussen R, Scheel I, Nacken A, Rehfuess E A
1Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.
2Department for Health Evidence, Radboud University Medical Center, P.O.Box 9101, 6500 HB Nijmegen, The Netherlands.
Cost Eff Resour Alloc. 2020 Feb 11;18:8. doi: 10.1186/s12962-020-0203-6. eCollection 2020.
Decision-making in public health and health policy is complex and requires careful deliberation of many and sometimes conflicting normative and technical criteria. Several approaches and tools, such as multi-criteria decision analysis, health technology assessments and evidence-to-decision (EtD) frameworks, have been proposed to guide decision-makers in selecting the criteria most relevant and appropriate for a transparent decision-making process. This study forms part of the development of the WHO-INTEGRATE EtD framework, a framework rooted in global health norms and values as reflected in key documents of the World Health Organization and the United Nations system. The objective of this study was to provide a comprehensive overview of criteria used in or proposed for real-world decision-making processes, including guideline development, health technology assessment, resource allocation and others.
We conducted an overview of systematic reviews through a combination of systematic literature searches and extensive reference searches. Systematic reviews reporting criteria used for real-world health decision-making by governmental or non-governmental organization on a supranational, national, or programme level were included and their quality assessed through a bespoke critical appraisal tool. The criteria reported in the reviews were extracted, de-duplicated and sorted into first-level (i.e. ), second-level (i.e. -) and third-level (i.e. ) categories. First-level categories were developed a priori using a normative approach; second- and third-level categories were developed inductively.
We included 36 systematic reviews providing criteria, of which one met all and another eleven met at least five of the items of our critical appraisal tool. The criteria were subsumed into 8 45 - and 200 . The first-level of the category system comprised the following seven substantive criteria: "Health-related balance of benefits and harms"; "Human and individual rights"; "Acceptability considerations"; "Societal considerations"; "Considerations of equity, equality and fairness"; "Cost and financial considerations"; and "Feasibility and health system considerations". In addition, we identified an eight criterion "Evidence".
This overview of systematic reviews provides a comprehensive overview of criteria used or suggested for real-world health decision-making. It also discusses key challenges in the selection of the most appropriate criteria and in seeking to implement a fair decision-making process.
公共卫生和卫生政策中的决策十分复杂，需要仔细权衡诸多有时相互冲突的规范性和技术性标准。已提出了多种方法和工具，如多标准决策分析、卫生技术评估以及证据到决策（EtD）框架，以指导决策者选择与透明决策过程最相关且合适的标准。本研究是世界卫生组织综合EtD框架开发工作的一部分，该框架基于世界卫生组织和联合国系统关键文件中所反映的全球卫生规范和价值观。本研究的目的是全面概述在实际决策过程中使用或提出的标准，包括指南制定、卫生技术评估、资源分配等。
我们通过系统文献检索和广泛的参考文献检索相结合的方式，对系统评价进行了概述。纳入了报告政府或非政府组织在超国家、国家或项目层面用于实际卫生决策的标准的系统评价，并通过定制的批判性评价工具对其质量进行评估。从评价中报告的标准进行提取、去重，并分类为一级（即 ）、二级（即 -）和三级（即 ）类别。一级类别采用规范性方法预先确定；二级和三级类别通过归纳法确定。
我们纳入了36项提供标准的系统评价，其中1项符合所有标准，另有11项至少符合我们批判性评价工具的5项标准。这些标准被归纳为8个 、45个 和200个 。类别系统的一级包括以下七个实质性标准：“健康相关的利弊平衡”；“人权与个人权利”；“可接受性考量”；“社会考量”；“公平、平等和公正考量”；“成本和财务考量”；以及“可行性和卫生系统考量”。此外，我们确定了第八个标准“证据”。
本系统评价概述提供了实际卫生决策中使用或建议使用的标准的全面概述。它还讨论了选择最合适标准以及寻求实施公平决策过程中的关键挑战。
