Bayón-Yusta Juan Carlos, Gutiérrez-Iglesias Asun, Galnares-Cordero Lorea, Gutiérrez-Ibarluzea Iñaki
Basque Foundation for Health Innovation and Research (BIOEF), Barakaldo, Spain.
Osteba, Basque Office for HTA, Barakaldo, Spain.
GMS Health Innov Technol. 2024 Mar 27;18:Doc02. doi: 10.3205/hta000139. eCollection 2024.
Countries fundamentally base macro and micro decision making in the field of health on economic considerations, the budgetary impact of technologies being a major criterion. Nevertheless, the value of the technology of interest and its dimensions are more complex if we seek to take decisions based on the value itself. The use of structured and explicit approaches that require the assessment of multiple criteria that reflect the dimensions of this value may significantly improve the quality of the decision making. Multi-criteria decision analysis (MCDA) is a complementary decision-making tool that is able to systematically incorporate dimensions or domains such as ethical, organisational, legal, environmental and social considerations, as well as costs and benefits of medical interventions, together with the distinct perspectives of the interested parties. The objective of this article is to propose the implementation of analysis of non-core domains, in reports of Health Technology Assessment (HTA) agencies/units. To assess the scientific evidence on MCDA techniques a systematic review was conducted using structured searches in biomedical databases and websites of various HTA organisations. A consensus group was held using the nominal group technique and involving users of healthcare services, providers, managers and academics. Complementary, a survey was sent to HTA agencies to ascertain the degree of implementation of MCDA in their methods. 42 articles reporting the use of non-core criteria for the assessment of health technologies were included in the analysis. From these articles, a total of 216 non-core criteria were retrieved and categorised into domains by the researchers, and of these, 56 were classified as socioeconomic, 59 as organisational, 10 as legal, 8 as environmental and 47 as ethical, while 36 were considered to relate to other domains. The consensus group, based on the 216 non-core criteria obtained from the systematic review, proposed, and defined 26 criteria that participants considered necessary for decision making in healthcare. The consensus group did not consider that any of the domains should be given more weight than others or that any individual criteria should dominate. These approaches can serve as a framework of reference for a well-structured systematic discussion concerning the basis of individual criteria and the evidence supporting them.
各国在卫生领域的宏观和微观决策基本上都基于经济考量，技术的预算影响是一个主要标准。然而，如果我们试图基于技术价值本身做出决策，那么相关技术的价值及其维度会更加复杂。使用结构化且明确的方法，要求对反映该价值维度的多个标准进行评估，可能会显著提高决策质量。多标准决策分析（MCDA）是一种辅助决策工具，能够系统地纳入伦理、组织、法律、环境和社会考量等维度或领域，以及医疗干预的成本和收益，同时兼顾相关各方的不同观点。本文的目的是在卫生技术评估（HTA）机构/单位的报告中提议实施非核心领域分析。为评估MCDA技术的科学证据，我们在生物医学数据库和各HTA组织的网站上进行结构化检索，开展了一项系统综述。使用名义群体技术召开了一次共识小组会议，参与者包括医疗服务使用者、提供者、管理者和学者。此外，还向HTA机构发送了一份调查问卷，以确定MCDA在其方法中的实施程度。分析纳入了42篇报告使用非核心标准评估卫生技术的文章。研究人员从这些文章中总共检索到216条非核心标准，并将其分类到不同领域，其中56条归类为社会经济领域，59条为组织领域，10条为法律领域，8条为环境领域，47条为伦理领域，另有36条被认为与其他领域相关。基于系统综述得出的216条非核心标准，共识小组提出并定义了26条参与者认为医疗保健决策所需的标准。共识小组认为，没有任何一个领域应比其他领域更具权重，也没有任何单个标准应占据主导地位。这些方法可作为一个参考框架，用于就各个标准的依据及其支持证据进行结构良好的系统讨论。
