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Dakin H, Tsiachristas A. Rationing in an Era of Multiple Tight Constraints: Is Cost-Utility Analysis Still Fit for Purpose? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:315-329. [PMID: 38329700 PMCID: PMC7615833 DOI: 10.1007/s40258-023-00858-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 02/09/2024]
Abstract
Cost-utility analysis may not be sufficient to support reimbursement decisions when the assessed health intervention requires a large proportion of the healthcare budget or when the monetary healthcare budget is not the only resource constraint. Such cases include joint replacement, coronavirus disease 2019 (COVID-19) interventions and settings where all resources are constrained (e.g. post-COVID-19 or in low/middle-income countries). Using literature on health technology assessment, rationing and reimbursement in healthcare, we identified seven alternative frameworks for simultaneous decisions about (dis)investment and proposed modifications to deal with multiple resource constraints. These frameworks comprised constrained optimisation; cost-effectiveness league table; 'step-in-the-right-direction' approach; heuristics based on effective gradients; weighted cost-effectiveness ratios; multicriteria decision analysis (MCDA); and programme budgeting and marginal analysis (PBMA). We used numerical examples to demonstrate how five of these alternative frameworks would operate. The modified frameworks we propose could be used in local commissioning and/or health technology assessment to supplement standard cost-utility analysis for interventions that have large budget impact and/or are subject to additional constraints.
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Affiliation(s)
- Helen Dakin
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, Headington, OX3 7LF, Oxford, UK.
| | - Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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Kapiriri L, Ieystn W, Vélez CM, Essue BM, Susan G, Danis M, Aguilera B. A global comparative analysis of the criteria and equity considerations included in eighty-six national COVID-19 plans. Health Policy 2024; 140:104961. [PMID: 38228031 DOI: 10.1016/j.healthpol.2023.104961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024]
Abstract
Systematic priority setting (PS), based on explicit criteria, is thought to improve the quality and consistency of the PS decisions. Among the PS criteria, there is increased focus on the importance of equity considerations and vulnerable populations. This paper discusses the PS criteria that were included in the national COVID-19 pandemic plans, with specific focus on equity and on the vulnerable populations considered. Secondary synthesis of data, from a global comparative study that examined the degree to which the COVID-19 plans included PS, was conducted. Only 32 % of the plans identified explicit criteria. Severity of the disease and/or disease burden were the commonly mentioned criteria. With regards to equity considerations and prioritizing vulnerable populations, 22 countries identified people with co-morbidities others mentioned children, women etc. Low social-economic status and internally displaced population were not identified in any of the reviewed national plans. The limited inclusion of explicit criteria and equity considerations highlight a need for policy makers, in all contexts, to consider instituting and equipping PS institutions who can engage diverse stakeholders in identifying the relevant PS criteria during the post pandemic period. While vulnerability will vary with the type of health emergency- awareness of this and having mechanisms for identifying and prioritizing the most vulnerable will support equitable pandemic responses.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada.
| | - Williams Ieystn
- School of Social Policy, HSMC, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK
| | - Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | - Beverley M Essue
- Centre for Global Health Research, St. Michael's Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada
| | - Goold Susan
- Internal Medicine and Health Management and Policy. Center for Bioethics and Social Sciences in Medicine, University of Michigan. 2800 Plymouth Road, Bldg. 14, G016, Ann Arbor, MI 48109-2800, USA
| | - Marion Danis
- Section on Ethics and Health Policy, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Bernardo Aguilera
- Facultad de Medicina y Ciencia, Universidad San Sebastian, Providencia, Santiago, Chile
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Meusel V, Mentzakis E, Baji P, Fiorentini G, Paolucci F. Priority setting in the German healthcare system: results from a discrete choice experiment. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:411-431. [PMID: 37184821 PMCID: PMC10462569 DOI: 10.1007/s10754-023-09347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 03/04/2023] [Indexed: 05/16/2023]
Abstract
Worldwide, social healthcare systems must face the challenges of a growing scarcity of resources and of its inevitable distributional effects. Explicit criteria are needed to define the boundaries of public reimbursement decisions. As Germany stands at the beginning of such a discussion, more formalised priority setting procedures seem in order. Recent research identified multi-criteria decision analysis (MCDA) as a promising approach to inform and to guide decision-making in healthcare systems. In that regard, this paper aims to analyse the relative weight assigned to various criteria in setting priority interventions in Germany. A discrete choice experiment (DCE) was employed in 2015 to elicit equity and efficiency preferences of 263 decision makers, through six attributes. The experiment allowed us to rate different policy interventions based on their features in a composite league table (CLT). As number of potential beneficiaries, severity of disease, individual health benefits and cost-effectiveness are the most relevant criteria for German decision makers within the sample population, the results display an overall higher preference towards efficiency criteria. Specific high priority interventions are mental disorders and cardiovascular diseases.
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Affiliation(s)
- V Meusel
- Faculty of Medicine, FAU Erlangen-Nürnberg, Erlangen, Germany.
| | - E Mentzakis
- Department of Economics, City University of London, Northampton Square, London, EC1V 0HB, UK
| | - P Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - G Fiorentini
- Department of Economics, University of Bologna, Bologna, Italy
| | - F Paolucci
- Sir Walter Murdoch School of Public Policy and International Affairs, Murdoch University, Perth, WA, Australia
- Department of Sociology and Law & Economics, University of Bologna, Bologna, Italy
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Ahumada-Canale A, Jeet V, Bilgrami A, Seil E, Gu Y, Cutler H. Barriers and facilitators to implementing priority setting and resource allocation tools in hospital decisions: A systematic review. Soc Sci Med 2023; 322:115790. [PMID: 36913838 DOI: 10.1016/j.socscimed.2023.115790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/24/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Health care budgets in high-income countries are having issues coping with unsustainable growth in demand, particularly in the hospital setting. Despite this, implementing tools systematising priority setting and resource allocation decisions has been challenging. This study answers two questions: (1) what are the barriers and facilitators to implementing priority setting tools in the hospital setting of high-income countries? and (2) what is their fidelity? A systematic review using the Cochrane methods was conducted including studies of hospital-related priority setting tools reporting barriers or facilitators for implementation, published after the year 2000. Barriers and facilitators were classified using the Consolidated Framework for Implementation Research (CFIR). Fidelity was assessed using priority setting tool's standards. Out of thirty studies, ten reported program budgeting and marginal analysis (PBMA), twelve multi-criteria decision analysis (MCDA), six health technology assessment (HTA) related frameworks, and two, an ad hoc tool. Barriers and facilitators were outlined across all CFIR domains. Implementation factors not frequently observed, such as 'evidence of previous successful tool application', 'knowledge and beliefs about the intervention' or 'external policy and incentives' were reported. Conversely, some constructs did not yield any barrier or facilitator including 'intervention source' or 'peer pressure'. PBMA studies satisfied the fidelity criteria between 86% and 100%, for MCDA it varied between 36% and 100%, and for HTA it was between 27% and 80%. However, fidelity was not related to implementation. This study is the first to use an implementation science approach. Results represent the starting point for organisations wishing to use priority setting tools in the hospital setting by providing an overview of barriers and facilitators. These factors can be used to assess readiness for implementation or to serve as the foundation for process evaluations. Through our findings, we aim to improve the uptake of priority setting tools and support their sustainable use.
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Affiliation(s)
- Antonio Ahumada-Canale
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Varinder Jeet
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Anam Bilgrami
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Elizabeth Seil
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Henry Cutler
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
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Uppal E, Khwaja J, Bomsztyk J, McCarthy H, Kothari J, Walton P, Scorer H, Kyriakou C, El-Sharkawi D, D'Sa S. The Rory Morrison WMUK Registry for Waldenström macroglobulinaemia: The growth of a national registry for a rare disorder. Br J Haematol 2023; 201:905-912. [PMID: 36698318 DOI: 10.1111/bjh.18680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/25/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023]
Abstract
National registries are used globally to characterise patient demographics, treatment choices and mortality to inform and improve clinical management. Waldenström macroglobulinaemia (WM) is a rare, treatment-responsive B-cell lymphoproliferative disorder with diverse clinical features and variable outcomes. To prospectively chart changes in the management of WM in the UK, the Rory Morrison Registry (RMR) was developed to systematically collect real-world data. Here we describe the development of the RMR, demonstrate its feasibility and describe preliminary observations. The RMR was devised as a collaborative project between patients and clinicians, under the auspices of the UK Charity for WM in 2016. Patients may be registered after the point of diagnosis and those with historic diagnosis were also eligible. Data collection fields were compiled by focus groups of clinicians, patients, industry and commissioning partners. The RMR launched in November 2017 and as of March 2022, there were 22 participating centres and 1305 patients registered. Median follow-up was 6.4 years, five-year overall survival 90.7% (95% confidence interval [CI] 88.4%-92.5%) and 10-year overall survival 79.3% (95% CI 75.7%-82.4%). There has been a clear evolution in treatments including a rapid growth in the use of Bruton's tyrosine kinase inhibitors in relapsed disease since their availability in the UK.
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Affiliation(s)
| | | | | | - Helen McCarthy
- University Hospitals Dorset NHS Foundation Trust, Dorset, UK
| | - Jaimal Kothari
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Miranda WDD, Silva GDMD, Fernandes LDMM, Silveira F, Sousa RPD. Health inequalities in Brazil: proposed prioritization to achieve the Sustainable Development Goals. CAD SAUDE PUBLICA 2023; 39:e00119022. [PMID: 37132719 DOI: 10.1590/0102-311xpt119022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/13/2023] [Indexed: 05/04/2023] Open
Abstract
This study aimed to develop a prioritization index to speed up the achievement of national health targets proposed in the 2030 Agenda. This is an ecological study that addressed the Health Regions in Brazil. The index incorporated 25 indicators with analytical proximity to the official indicators of the 2030 Agenda whose data are available from public municipal sources for the period of 2015-2019. According to our study, the index was a powerful method to support health management decisions. The results showed the most vulnerable territories are located in the North Region of the country, and therefore, these are priority areas for resource allocation. The analysis of subindices highlighted local health bottlenecks, reinforcing the need for municipalities in each region to set their own priorities while making decisions for health resource allocation. By indicating Health Regions and priority themes for more investments, this investigation shows paths to support the implementation of the 2030 Agenda, from the local to the national level, in addition to providing elements that can be used by policy makers to minimize the effects of social inequalities on health, prioritizing territories with worse indices.
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Affiliation(s)
| | | | | | - Fabrício Silveira
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil
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Ashraf S, Abdullah S, Almagrabi AO. A new emergency response of spherical intelligent fuzzy decision process to diagnose of COVID19. Soft comput 2023; 27:1809-1825. [PMID: 33024412 PMCID: PMC7529095 DOI: 10.1007/s00500-020-05287-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The control of spreading of COVID-19 in emergency situation the entire world is a challenge, and therefore, the aim of this study was to propose a spherical intelligent fuzzy decision model for control and diagnosis of COVID-19. The emergency event is known to have aspects of short time and data, harmfulness, and ambiguity, and policy makers are often rationally bounded under uncertainty and threat. There are some classic approaches for representing and explaining the complexity and vagueness of the information. The effective tool to describe and reduce the uncertainty in data information is fuzzy set and their extension. Therefore, we used fuzzy logic to develop fuzzy mathematical model for control of transmission and spreading of COVID19. The fuzzy control of early transmission and spreading of coronavirus by fuzzy mathematical model will be very effective. The proposed research work is on fuzzy mathematical model of intelligent decision systems under the spherical fuzzy information. In the proposed work, we will develop a newly and generalized technique for COVID19 based on the technique for order of preference by similarity to ideal solution (TOPSIS) and complex proportional assessment (COPRAS) methods under spherical fuzzy environment. Finally, an illustrative the emergency situation of COVID-19 is given for demonstrating the effectiveness of the suggested method, along with a sensitivity analysis and comparative analysis, showing the feasibility and reliability of its results.
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Affiliation(s)
- Shahzaib Ashraf
- Department of Mathematics, Abdul Wali Khan University, Mardan, 23200 Pakistan
| | - Saleem Abdullah
- Department of Mathematics, Abdul Wali Khan University, Mardan, 23200 Pakistan
| | - Alaa O. Almagrabi
- Department of Information Systems, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
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Kulesa J, Chua I, Ferrer K, Kind T, Kern J. Prioritization and Resource Allocation in Academic Global Health Partnerships. Acad Pediatr 2022; 23:829-838. [PMID: 36280039 DOI: 10.1016/j.acap.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE US-based academic institutions involved in global health (GH) partnerships can have a positive impact on health care systems in low/middle-income countries but lack a consistent approach. Existing priority setting and resource allocation (PSRA) frameworks do not adequately capture the interpersonal and sociopolitical complexity of decision-making in GH work. The authors explored how US-based GH practitioners prioritize and allocate resources for different types of support in academic GH partnerships. METHOD In 2020 to 2021, the authors invited 36 US-based GH practitioners from the 2015 Pediatric GH Leadership Conference to participate in individual 1-hour semi-structured interviews. Using an iterative and inductive grounded theory approach, the study team analyzed interview transcripts through the lens of Heyse's framework on decision-making in humanitarian aid. RESULTS The authors interviewed 20 GH practitioners and reached thematic sufficiency. A descriptive conceptual framework, capturing 18 distinct themes in 4 major categories, emerged from the data. In this framework, categories included: 1) stakeholders: those who influence and are influenced by the partnership; 2) goals: vision, mission, aims, and scope of the partnership; 3) implementation strategy: approach to accomplishing goals, categorized as relationship-oriented, task-oriented, context-oriented, or nonprescriptive; and 4) approach to conflict: response when goals and strategies do not align among stakeholders. CONCLUSION Themes revealed a dynamic process for PSRA. Using our study findings, and building on existing literature, our framework highlights the complex interpersonal relationships, resource limitations, and sociopolitical and economic constraints that affect PSRA in GH partnerships. Finally, themes point to the field's evolution toward a more decolonized approach to GH.
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Affiliation(s)
- John Kulesa
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences (J Kulesa, I Chua, K Ferrer, T Kind, and J Kern), Washington, DC; Division of Hospital Medicine, Children's National Hospital (J Kulesa, I Chua, K Ferrer, and J Kern), Washington, DC.
| | - Ian Chua
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences (J Kulesa, I Chua, K Ferrer, T Kind, and J Kern), Washington, DC; Division of Hospital Medicine, Children's National Hospital (J Kulesa, I Chua, K Ferrer, and J Kern), Washington, DC; Department of Pediatrics, Stanford University School of Medicine (I Chua), Stanford, Calif
| | - Kathy Ferrer
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences (J Kulesa, I Chua, K Ferrer, T Kind, and J Kern), Washington, DC; Division of Hospital Medicine, Children's National Hospital (J Kulesa, I Chua, K Ferrer, and J Kern), Washington, DC
| | - Terry Kind
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences (J Kulesa, I Chua, K Ferrer, T Kind, and J Kern), Washington, DC; Division of General and Community Pediatrics, Children's National Hospital (T Kind), Washington, DC
| | - Jeremy Kern
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences (J Kulesa, I Chua, K Ferrer, T Kind, and J Kern), Washington, DC; Division of Hospital Medicine, Children's National Hospital (J Kulesa, I Chua, K Ferrer, and J Kern), Washington, DC
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Martinus Hauge A, Otto EI, Wadmann S. The sociology of rationing: Towards increased interdisciplinary dialogue - A critical interpretive literature review. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:1287-1304. [PMID: 35692110 PMCID: PMC9546068 DOI: 10.1111/1467-9566.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
Since the 1990s, the sociology of rationing has developed in explicit opposition to health economic and bioethical approaches to healthcare rationing. This implies a limited engagement with other disciplines and a limited impact on political debates. To bring the sociology of rationing into an interdisciplinary dialogue, it is important to understand the disciplines' analytical differences and similarities. Based on a critical interpretive literature synthesis, this article examines four disciplinary perspectives on healthcare rationing and priority setting: (1) Health economics, which seeks to develop decision models to provide for more rational resource allocation; (2) Bioethics, which seeks to develop normative principles and procedures to facilitate a just allocation of resources; (3) Health policy studies, which focus on issues of legitimacy and implementation of decision models; and lastly (4) Sociology, which analyses the uncertainty of rationing and the resulting value conflicts and negotiations. The article provides an analytical overview and suggestions on how to advance the impact of sociological arguments in future rationing debates: Firstly, we discuss how to develop the concepts and assumptions of the sociology of rationing. Secondly, we identify specific themes relevant for sociological inquiry, including the recurring problem of how to translate administrative priority setting decisions into clinical practice.
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Affiliation(s)
| | - Eva Iris Otto
- Department of AnthropologyCopenhagen UniversityCopenhagenDenmark
| | - Sarah Wadmann
- VIVE – The Danish Center for Social Science ResearchCopenhagenDenmark
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Mathiesen TI, Balak N, Samprón N, Broekman M, Bolger C. Ethico-legal regional differences in European neurosurgical practice: Part 1-pre-COVID-19 era. BRAIN & SPINE 2022; 2:100899. [PMID: 36248159 PMCID: PMC9562226 DOI: 10.1016/j.bas.2022.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/30/2022] [Accepted: 06/02/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Professionalism entails expert knowledge, self-regulation, accountability, and professional ethics. These factors are influenced by culture, political observance, professional maturity, education, and occupation; ethical practices may thus vary between countries and affect how neurosurgery is practiced. RESEARCH QUESTION This paper aims to conduct a survey that addresses whether ethico-legal practices differ in European countries and whether existing ethical guidelines have been implemented. MATERIAL AND METHODS A questionnaire survey was used to examine the ethico-legal situation in 29 European countries or regions. The reports were validated by representatives of each nation. RESULTS Existing guidelines had been implemented to a minimal extent. Major regional and national differences were found in attitudes toward life and death, prioritization, and issues related to professional conduct. DISCUSSION AND CONCLUSION The results of this survey reveal inadequacies and weaknesses of policies and resources, which should spark national discussions to improve the conditions that influence professional ethics. Unfortunately, only a minority of neurosurgeons know the neurosurgical ethics guidelines and apply them in their decision making. Our findings highlight the importance of values and professional ethics in decision making.
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Affiliation(s)
- Tiit I. Mathiesen
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Marike Broekman
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, The Hague, the Netherlands
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Ciarán Bolger
- Department of Clinical Neuroscience, Beaumont Hospital, Dublin, Ireland
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
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Kleinhout-Vliek TH, De Bont AA, Boer A. Under careful construction: combining findings, arguments, and values into robust health care coverage decisions. BMC Health Serv Res 2022; 22:756. [PMID: 35672735 PMCID: PMC9175321 DOI: 10.1186/s12913-022-07781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background Health care coverage decisions deal with health care technology provision or reimbursement at a national level. The coverage decision report, i.e., the publicly available document giving reasons for the decision, may contain various elements: quantitative calculations like cost and clinical effectiveness analyses and formalised and non-formalised qualitative considerations. We know little about the process of combining these heterogeneous elements into robust decisions. Methods This study describes a model for combining different elements in coverage decisions. We build on two qualitative cases of coverage appraisals at the Dutch National Health Care Institute, for which we analysed observations at committee meetings (n = 2, with field notes taken) and the corresponding audio files (n = 3), interviews with appraisal committee members (n = 10 in seven interviews) and with Institute employees (n = 5 in three interviews), and relevant documents (n = 4). Results We conceptualise decisions as combinations of elements, specifically (quantitative) findings and (qualitative) arguments and values. Our model contains three steps: 1) identifying elements; 2) designing the combinations of elements, which entails articulating links, broadening the scope of designed combinations, and black-boxing links; and 3) testing these combinations and choosing one as the final decision. Conclusions Based on the proposed model, we suggest actively identifying a wider variety of elements and stepping up in terms of engaging patients and the public, including facilitating appeals. Future research could explore how different actors perceive the robustness of decisions and how this relates to their perceived legitimacy.
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Affiliation(s)
- T H Kleinhout-Vliek
- Erasmus School of Health Policy & Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands. .,Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, the Netherlands.
| | - A A De Bont
- Erasmus School of Health Policy & Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - A Boer
- Erasmus School of Health Policy & Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
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Grill C. Involving stakeholders in research priority setting: a scoping review. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:75. [PMID: 34715932 PMCID: PMC8555197 DOI: 10.1186/s40900-021-00318-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/18/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND This scoping review provides a thorough analysis of how stakeholders have so far been involved in research priority setting. The review describes, synthesizes, and evaluates research priority setting projects not only for the field of health-as previous reviews have done-but does so on a much broader scale for any research area. METHODS A comprehensive electronic literature search was conducted in the databases PubMed, Scopus, and Web of Science. Reflecting the importance of grey literature, Google Scholar and relevant websites were also screened for eligible publications. A computational approach was then used for the study selection. The final screening for inclusion was done manually. RESULTS The scoping review encompasses 731 research priority setting projects published until the end of 2020. Overall, the projects were conducted within the realm of 50 subject areas ranging from agriculture and environment over health to social work and technology. Key learnings include that nearly all priority setting projects aimed to identify research priorities for the field of health (93%), particularly for nursing and care, cancer, pediatrics, and mental, behavioral and neurodevelopmental disorders. Only 6% of the projects were not health-related and 1% identified research priorities at the interface between health and a non-health area. Over time, 30 different stakeholder groups took part in research priority setting. The stakeholders most frequently asked to identify research priorities were doctors, patients, academics/researchers, nurses, allied healthcare professionals, family members, friends, and carers. Nearly two thirds of all projects have been conducted in Europe and North America. Overall, only 9% of the projects emphasized the importance of stakeholders in their goals and rationales and actively involved them. In around a quarter of the projects, stakeholders deliberated on their research priorities throughout the entire process. CONCLUSION By mapping out the complex landscape of stakeholder involvement in research priority setting, this review guides future efforts to involve stakeholders effectively, inclusively, and transparently, which in turn may increase the overall value of research for society. As a practical addition to this review, the first worldwide research priority setting database was created: https://ois.lbg.ac.at/en/project-database . The database contains all the projects analyzed for this review and is constantly updated with the latest published research priority setting projects.
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Affiliation(s)
- Christiane Grill
- Ludwig Boltzmann Gesellschaft (LBG), Open Innovation in Science Center, Nussdorfer Strasse 64/2, 1090, Vienna, Austria.
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Khan A, Abosuliman SS, Ashraf S, Abdullah S. Hospital admission and care of COVID‐19 patients problem based on spherical hesitant fuzzy decision support system. INT J INTELL SYST 2021. [DOI: 10.1002/int.22455] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Aziz Khan
- Department of Mathematics Abdul Wali Khan University Mardan, Khyber Pakhtunkhwa Pakistan
| | - Shougi S. Abosuliman
- Department of Supply Chain and Maritime Business, Faculty of Maritime Studies King Abdulaziz University Jeddah Saudi Arabia
| | - Shahzaib Ashraf
- Department of Mathematics and Statistics Bacha Khan University Charsadda, Khyber Pakhtunkhwa Pakistan
| | - Saleem Abdullah
- Department of Mathematics Abdul Wali Khan University Mardan, Khyber Pakhtunkhwa Pakistan
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14
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Kislov R, Checkland K, Wilson PM, Howard SJ. 'Real-world' priority setting for service improvement in English primary care: a decentred approach. PUBLIC MANAGEMENT REVIEW 2021; 25:150-174. [PMID: 36624816 PMCID: PMC9821632 DOI: 10.1080/14719037.2021.1942534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This article develops an analysis of population-level priority setting informed by Bevir's decentred theory of governance and drawing on a qualitative study of priority setting for service improvement conducted in the complex multi-layered governance context of English primary care. We show how powerful actors, operating at the meso-level, utilize pluralistic and contradictory elements of complex governance networks to discursively construct, legitimize and enact service improvement priorities. Our analysis highlights the role of situated agency in integrating top-down, bottom-up and horizontal influences on priority setting, which leads to variation in local priorities despite the continuous presence of strong hierarchical influences.
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Affiliation(s)
- Roman Kislov
- Business School, Manchester Metropolitan University, Manchester, UK
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Kath Checkland
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Paul M. Wilson
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Susan J. Howard
- National Institute for Health Research Applied Research Collaboration Greater Manchester, Health Innovation Manchester, Manchester, UK
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15
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Kan K, Jörg F, Lokkerbol J, Mihalopoulos C, Buskens E, Schoevers RA, Feenstra TL. More than cost-effectiveness? Applying a second-stage filter to improve policy decision making. Health Expect 2021; 24:1413-1423. [PMID: 34061430 PMCID: PMC8369110 DOI: 10.1111/hex.13277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/24/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023] Open
Abstract
Background Apart from cost‐effectiveness, considerations like equity and acceptability may affect health‐care priority setting. Preferably, priority setting combines evidence evaluation with an appraisal procedure, to elicit and weigh these considerations. Objective To demonstrate a structured approach for eliciting and evaluating a broad range of assessment criteria, including key stakeholders’ values, aiming to support decision makers in priority setting. Methods For a set of cost‐effective substitute interventions for depression care, the appraisal criteria were adopted from the Australian Assessing Cost‐Effectiveness initiative. All substitute interventions were assessed in an appraisal, using focus group discussions and semi‐structured interviews conducted among key stakeholders. Results Appraisal of the substitute cost‐effective interventions yielded an overview of considerations and an overall recommendation for decision makers. Two out of the thirteen pairs were deemed acceptable and realistic, that is investment in therapist‐guided and Internet‐based cognitive behavioural therapy instead of cognitive behavioural therapy in mild depression, and investment in combination therapy rather than individual psychotherapy in severe depression. In the remaining substitution pairs, substantive issues affected acceptability. The key issues identified were as follows: workforce capacity, lack of stakeholder support and the need for change in clinicians’ attitude. Conclusions Systematic identification of stakeholders’ considerations allows decision makers to prioritize among cost‐effective policy options. Moreover, this approach entails an explicit and transparent priority‐setting procedure and provides insights into the intended and unintended consequences of using a certain health technology. Patient contribution Patients were involved in the conduct of the study for instance, by sharing their values regarding considerations relevant for priority setting.
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Affiliation(s)
- Kaying Kan
- Rob Giel Research Center, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Frederike Jörg
- Rob Giel Research Center, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands.,Research Department, GGZ Friesland, Leeuwarden, The Netherlands
| | - Joran Lokkerbol
- Centre for Economic Evaluation and Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Erik Buskens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Robert A Schoevers
- Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Talitha L Feenstra
- Department of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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16
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Iqbal H, West J, Haith-Cooper M, McEachan RRC. A systematic review to identify research priority setting in Black and minority ethnic health and evaluate their processes. PLoS One 2021; 16:e0251685. [PMID: 34048459 PMCID: PMC8162667 DOI: 10.1371/journal.pone.0251685] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 05/01/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Black, Asian and minority ethnic communities suffer from disproportionately poorer health than the general population. This issue has been recently exemplified by the large numbers of infection rates and deaths caused by covid-19 in BAME populations. Future research has the potential to improve health outcomes for these groups. High quality research priority setting is crucial to effectively consider the needs of the most vulnerable groups of the population. OBJECTIVE The purpose of this systematic review is to identify existing research priority studies conducted for BAME health and to determine the extent to which they followed good practice principles for research priority setting. METHOD Included studies were identified by searching Medline, Cinnahl, PsychINFO, Psychology and Behavioral Sciences Collection, as well as searches in grey literature. Search terms included "research priority setting", "research prioritisation", "research agenda", "Black and minority ethnic", "ethnic group". Studies were included if they identified or elicited research priorities for BAME health and if they outlined a process of conducting a research prioritisation exercise. A checklist of Nine Common Themes of Good Practice in research priority setting was used as a methodological framework to evaluate the research priority processes of each study. RESULTS Out of 1514 citations initially obtained, 17 studies were included in the final synthesis. Topic areas for their research prioritisation exercise included suicide prevention, knee surgery, mental health, preterm birth, and child obesity. Public and patient involvement was included in eleven studies. Methods of research prioritisation included workshops, Delphi techniques, surveys, focus groups and interviews. The quality of empirical evidence was diverse. None of the exercises followed all good practice principles as outlined in the checklist. Areas that were lacking in particular were: the lack of a comprehensive approach to guide the process; limited use of criteria to guide discussion around priorities; unequal or no representation from ethnic minorities, and poor evaluation of their own processes. CONCLUSIONS Research priority setting practices were found to mostly not follow good practice guidelines which aim to ensure rigour in priority setting activities and support the inclusion of BAME communities in establishing the research agenda. Research is unlikely to deliver useful findings that can support relevant research and positive change for BAME communities unless they fulfil areas of good practice such as inclusivity of key stakeholders' input, planning for implementation of identified priorities, criteria for deciding on priorities, and evaluation of their processes in research priority setting.
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Affiliation(s)
- Halima Iqbal
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, United Kingdom
- * E-mail:
| | - Jane West
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, United Kingdom
| | | | - Rosemary R. C. McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, United Kingdom
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17
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Hunter J, Grant S, Delaney GP, Templeman K, Ussher J, Parton C, Kellett A, Smith C. Barriers and Facilitators to Integrative Oncology Services in Australia: A Changed Mind Set Required. J Altern Complement Med 2021; 27:S89-S98. [PMID: 33788601 DOI: 10.1089/acm.2020.0299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: This study aimed to explore barriers and facilitators to integrative oncology (IO) service provision and access in Australia. Design: The study design was mixed method with two substudies: a cross-sectional national cancer service survey of public and private sectors; and focus group interviews and an online survey of cancer survivors. Triangulation analysis of qualitative and quantitative data was used to identify and interrogate meta-themes. Subjects: The cancer service response rate was 93.2% (n = 275/295); 71/275 (25.8%) provided IO. Thirty-three cancer survivors from Anglo-European, Arabic, Vietnamese, and Chinese backgrounds were interviewed, and 121 survivors answered the online survey. Results: IO gaps were substantial, with no services in many regions and cities; a lack of diversity and availability of therapeutic options, including culturally appropriate services; and a mismatch between the high use of natural health products by survivors and types of IO services provided. Two overlapping meta-themes were identified: "barriers and facilitators" and "peoples and institutions"; each with four subthemes, respectively, "access/provision, affordability/funding, information/evidence, and culture/values" and "cancer survivors, healthcare professionals, organizations, and policies." While affordability/funding was the greatest barrier to survivors and providers, solutions varied (e.g., building a stronger evidence-base, business model advice) and often conflicted (e.g., public verses private sector funding). The most insidious barrier was professional/corporate cultures and values that influenced hospital policies (or lack thereof), conceptions of evidence and the therapeutic alliance. Survivors called for a change of mindset in the culture of medicine and value-based health care. Conclusions: The barriers and facilitators to IO services were more complex than building the evidence-base and demonstrating value to justify funding. To achieve a better alignment of patients' preferences with service provision, providers require more guidance on clinical governance, business models, local service gaps, and interprofessional collaboration. National strategies and funding models are needed to ensure appropriate, equitable IO service provision.
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Affiliation(s)
- Jennifer Hunter
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Suzanne Grant
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Geoff P Delaney
- South-Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, Australia.,Cancer Services, South Western Sydney Local Health District, Liverpool, Australia
| | - Kate Templeman
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Jane Ussher
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Chloe Parton
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Andrew Kellett
- School of Medicine, Western Sydney University, Penrith, Australia
| | - Caroline Smith
- NICM Health Research Institute, Western Sydney University, Penrith, Australia.,Graduate Research School, Western Sydney University, Penrith, Australia
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18
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Sohn H, Sweeney S, Mudzengi D, Creswell J, Menzies NA, Fox GJ, MacPherson P, Dowdy DW. Determining the value of TB active case-finding: current evidence and methodological considerations. Int J Tuberc Lung Dis 2021; 25:171-181. [PMID: 33688805 PMCID: PMC8647907 DOI: 10.5588/ijtld.20.0565] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Active case-finding (ACF) is an important component of the End TB Strategy. However, ACF is resource-intensive, and the economics of ACF are not well-understood. Data on the costs of ACF are limited, with little consistency in the units and methods used to estimate and report costs. Mathematical models to forecast the long-term effects of ACF require empirical measurements of the yield, timing and costs of case detection. Pragmatic trials offer an opportunity to assess the cost-effectiveness of ACF interventions within a 'real-world´ context. However, such analyses generally require early introduction of economic evaluations to enable prospective data collection on resource requirements. Closing the global case-detection gap will require substantial additional resources, including continued investment in innovative technologies. Research is essential to the optimal implementation, cost-effectiveness, and affordability of ACF in high-burden settings. To assess the value of ACF, we must prioritize the collection of high-quality data regarding costs and effectiveness, and link those data to analytical models that are adapted to local settings.
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Affiliation(s)
- H Sohn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S Sweeney
- London School of Hygiene & Tropical Medicine, London, UK
| | - D Mudzengi
- The Aurum Institute, Johannesburg, South Africa
| | - J Creswell
- The Stop TB Partnership, UNOPS, Geneva, Switzerland
| | - N A Menzies
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - G J Fox
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - P MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Malawi, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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19
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Employing multiple-attribute utility technology to evaluate publicity activities for cancer information and counseling programs in Japan. J Cancer Policy 2021; 27:100261. [DOI: 10.1016/j.jcpo.2020.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/05/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022]
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20
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Athanasakis K, Kyriopoulos I, Kyriopoulos J. Can We Incorporate Societal Values in Resource Allocation Decisions Among Disease Categories? An Empirical Approach. Value Health Reg Issues 2021; 25:29-36. [PMID: 33636478 DOI: 10.1016/j.vhri.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/14/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Historically, resource allocation decisions in healthcare are based on univariate approaches, inevitably overlooking value dimensions that are essential from a societal welfare maximization perspective. This article aims to present a wider perspective on decision making that incorporates societal values when prioritizing future resource allocation among disease areas. METHODS Sociotechnical application of multiple-criteria decision analysis with a set of criteria (value judgments) that are based on positive as well as normative dimensions of resource allocation. We use Greece as a case study. Societal value judgments were sourced via a multidisciplinary panel of experts who collectively provided criteria weights and scores for each alternative (16 disease categories, classified according to the Global Burden of Disease study) against each criterion. An additive value function provided the total value in priority preference for each alternative. RESULTS The criteria that were deemed relevant to the decision-making process and their respective relative weights were burden of disease (0.245), capacity to benefit (0.190), direct cost and projected changes in the next 5 years (0.160), indirect cost (0.132), intensity of unmet needs (0.109), incidence of catastrophic expenditure (0.091), and caring externalities (0.073). The additive value function revealed that the top 5 priorities in highest total value scores were neoplasms, circulatory diseases, injuries, neurologic diseases, and musculoskeletal diseases. CONCLUSIONS Incorporation of societal value criteria in resource allocation decisions can highlight priorities and lead to different sets of planning decisions than solely demand-driven allocation.
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Affiliation(s)
- Kostas Athanasakis
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece.
| | - Ilias Kyriopoulos
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece; LSE Health, London School of Economics and Political Science, London, United Kingdom
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21
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Seixas BV, Regier DA, Bryan S, Mitton C. Describing practices of priority setting and resource allocation in publicly funded health care systems of high-income countries. BMC Health Serv Res 2021; 21:90. [PMID: 33499854 PMCID: PMC7839200 DOI: 10.1186/s12913-021-06078-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/12/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthcare spending has grown over the last decades in all developed countries. Making hard choices for investments in a rational, evidence-informed, systematic, transparent and legitimate manner constitutes an important objective. Yet, most scientific work in this area has focused on developing/improving prescriptive approaches for decision making and presenting case studies. The present work aimed to describe existing practices of priority setting and resource allocation (PSRA) within the context of publicly funded health care systems of high-income countries and inform areas for further improvement and research. METHODS An online qualitative survey, developed from a theoretical framework, was administered with decision-makers and academics from 18 countries. 450 individuals were invited and 58 participated (13% of response rate). RESULTS We found evidence that resource allocation is still largely carried out based on historical patterns and through ad hoc decisions, despite the widely held understanding that decisions should be based on multiple explicit criteria. Health technology assessment (HTA) was the tool most commonly indicated by respondents as a formal priority setting strategy. Several approaches were reported to have been used, with special emphasis on Program Budgeting and Marginal Analysis (PBMA), but limited evidence exists on their evaluation and routine use. Disinvestment frameworks are still very rare. There is increasing convergence on the use of multiple types of evidence to judge the value of investment options. CONCLUSIONS Efforts to establish formal and explicit processes and rationales for decision-making in priority setting and resource allocation have been still rare outside the HTA realm. Our work indicates the need of development/improvement of decision-making frameworks in PSRA that: 1) have well-defined steps; 2) are based on multiple criteria; 3) are capable of assessing the opportunity costs involved; 4) focus on achieving higher value and not just on adoption; 5) engage involved stakeholders and the general public; 6) make good use and appraisal of all evidence available; and 6) emphasize transparency, legitimacy, and fairness.
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Affiliation(s)
- Brayan V Seixas
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), USA.
| | - Dean A Regier
- Cancer Control Research, BC Cancer and the Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
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22
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Seixas BV, Dionne F, Mitton C. Practices of decision making in priority setting and resource allocation: a scoping review and narrative synthesis of existing frameworks. HEALTH ECONOMICS REVIEW 2021; 11:2. [PMID: 33411161 PMCID: PMC7789400 DOI: 10.1186/s13561-020-00300-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/16/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Due to growing expenditures, health systems have been pushed to improve decision-making practices on resource allocation. This study aimed to identify which practices of priority setting and resource allocation (PSRA) have been used in healthcare systems of high-income countries. METHODS A scoping literature review (2007-2019) was conducted to map empirical PSRA activities. A two-stage screening process was utilized to identify existing approaches and cluster similar frameworks. That was complemented with a gray literature and horizontal scanning. A narrative synthesis was carried out to make sense of the existing literature and current state of PSRA practices in healthcare. RESULTS One thousand five hundred eighty five references were found in the peer-reviewed literature and 25 papers were selected for full-review. We identified three major types of decision-making framework in PSRA: 1) Program Budgeting and Marginal Analysis (PBMA); 2) Health Technology Assessment (HTA); and 3) Multiple-criteria value assessment. Our narrative synthesis indicates these formal frameworks of priority setting and resource allocation have been mostly implemented in episodic exercises with poor follow-up and evaluation. There seems to be growing interest for explicit robust rationales and ample stakeholder involvement, but that has not been the norm in the process of allocating resources within healthcare systems of high-income countries. CONCLUSIONS No single dominate framework for PSRA appeared as the preferred approach across jurisdictions, but common elements exist both in terms of process and structure. Decision-makers worldwide can draw on our work in designing and implementing PSRA processes in their contexts.
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Affiliation(s)
- Brayan V. Seixas
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, USA
| | | | - Craig Mitton
- Center for Clinical Epidemiology and Evaluation, Vancouver, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, Canada
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23
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Seixas BV, Mitton C. Using a Formal Strategy of Priority Setting to Mitigate Austerity Effects Through Gains in Value: The Role of Program Budgeting and Marginal Analysis (PBMA) in the Brazilian Public Healthcare System. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:9-15. [PMID: 32468409 DOI: 10.1007/s40258-020-00591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The fiscal regime implemented in Brazil with the constitutional amendment 95 (EC-95) of December 2016 froze primary expenditures for 20 years, including healthcare spending. Previous studies have estimated strong negative effects of this policy on the health of Brazilians. Although there has been a constant pressure to repeal EC-95, this policy is unlikely to be changed in the near future. Thus, there is also a need to take actions within its own terms in order to mitigate its harmful consequences on population health. Shedding light on the existing evidence about the impact of austerity on health, the present work discusses how decision-makers can use a formal framework of decision making in priority setting and resource allocation to tackle the amplified budgetary strain. Drawing on principles of Program Budgeting and Marginal Analysis (PBMA), efficiency can be improved by shifting spending from low-value to higher-value areas, avoiding the "across-the-board cut" caused by non-differential consideration of expenditures in a context of mismatched growth of demand and supply of healthcare. By evaluating opportunity costs of investment and disinvestment proposals on the basis of multiple criteria and marginal analysis, the Brazilian public healthcare system could obtain gains in value, achieving better performance and attenuating the relative decline in spending on health brought by an austerity scenario.
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Affiliation(s)
- Brayan V Seixas
- Department of Health Policy and Management, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
- UCLA Center for Health Policy Research (CHPR), Los Angeles, CA, USA.
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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Kleinhout-Vliek T, de Bont A, Boysen M, Perleth M, van der Veen R, Zwaap J, Boer B. Around the Tables - Contextual Factors in Healthcare Coverage Decisions Across Western Europe. Int J Health Policy Manag 2020; 9:390-402. [PMID: 32610740 PMCID: PMC7557427 DOI: 10.15171/ijhpm.2019.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/17/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Across Western Europe, procedures and formalised criteria for taking decisions on the coverage (inclusion in the benefits basket or equivalent) of healthcare technologies vary substantially. In the decision documents, which display the justification of, the rationale for, these decisions, national healthcare institutes may employ ‘contextual factors,’ defined here as situation-specific considerations. Little is known about how the use of such contextual factors compares across countries. We describe and compare contextual factors as used in coverage decisions generally and 4 decision documents specifically in Belgium, England, Germany, and the Netherlands. Methods: Four group interviews with 3 experts from the national healthcare institute of each country, document and web site analysis, and a workshop with 1 to 2 of these experts per country were followed by the examination of the documents of 4 specific decisions taken in each of the 4 countries, sampled to vary widely in type of technology and decision outcome. Results: From the available decision documents, we conclude that in every country studied, contextual factors are established ‘around the table,’ ie, in deliberation. All documents examined feature contextual factors, with similar contextual factor patterns leading to similar decisions in different countries. The Dutch decisions employ the widest variety of factors, with the exception of the societal functioning of the patient, which is relatively common in Belgium, England, and Germany. Half of the final decisions were taken in another setting, with the consequence that no documentation was retrievable for 2 decisions. Conclusion: First, we conclude that in these countries, contextual factors are actively integrated in the decision document, and that this is achieved in deliberation. Conceptualising contextual factors as both situation-specific and actively-integrated affords insight into practices of contextualisation and provides an encouragement for exchange between decision-makers on more qualitative aspects of decisions. Second, the decisions that lacked a publicly accessible justification of the final decision document raised questions on the decisions’ legitimacy. Further research could address patterning of contextual factors, elucidate why some factors may remain implicit, and how decisions without a publicly available decision document may enable or restrain decision-making practice.
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Affiliation(s)
- Tineke Kleinhout-Vliek
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Antoinette de Bont
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Meindert Boysen
- National Institute for Health and Care Excellence (NICE), London, UK
| | - Matthias Perleth
- Federal Joint Committee (Gemeinsamer Bundesausschuss), Berlin, Germany
| | - Romke van der Veen
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jacqueline Zwaap
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
| | - Bert Boer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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25
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The Movember Prostate Cancer Landscape Analysis: an assessment of unmet research needs. Nat Rev Urol 2020; 17:499-512. [PMID: 32699318 PMCID: PMC7462750 DOI: 10.1038/s41585-020-0349-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Abstract
Prostate cancer is a heterogeneous cancer with widely varying levels of morbidity and mortality. Approaches to prostate cancer screening, diagnosis, surveillance, treatment and management differ around the world. To identify the highest priority research needs across the prostate cancer biomedical research domain, Movember conducted a landscape analysis with the aim of maximizing the effect of future research investment through global collaborative efforts and partnerships. A global Landscape Analysis Committee (LAC) was established to act as an independent group of experts across urology, medical oncology, radiation oncology, radiology, pathology, translational research, health economics and patient advocacy. Men with prostate cancer and thought leaders from a variety of disciplines provided a range of key insights through a range of interviews. Insights were prioritized against predetermined criteria to understand the areas of greatest unmet need. From these efforts, 17 research needs in prostate cancer were agreed on and prioritized, and 3 received the maximum prioritization score by the LAC: first, to establish more sensitive and specific tests to improve disease screening and diagnosis; second, to develop indicators to better stratify low-risk prostate cancer for determining which men should go on active surveillance; and third, to integrate companion diagnostics into randomized clinical trials to enable prediction of treatment response. On the basis of the findings from the landscape analysis, Movember will now have an increased focus on addressing the specific research needs that have been identified, with particular investment in research efforts that reduce disease progression and lead to improved therapies for advanced prostate cancer. The Movember global Landscape Analysis Committee (LAC) was established to act as an independent group of experts across urology, medical oncology, radiation oncology, radiology, pathology, translational research, health economics and patient advocacy to identify the highest priority research needs across the prostate cancer biomedical research domain. Findings from the landscape analysis illustrate the research priorities in prostate cancer and will enable Movember to focus on specific needs, with particular investment in research to reduce disease progression and improve therapies for advanced prostate cancer.
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Munday J, Higgins N, Mathew S, Dalgleish L, Batterbury AS, Burgess L, Campbell J, Delaney LJ, Griffin BR, Hughes JA, Ingleman J, Keogh S, Coyer F. Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review. J Multidiscip Healthc 2020; 13:647-660. [PMID: 32821111 PMCID: PMC7419608 DOI: 10.2147/jmdh.s255785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Nurses provide care at each phase of the complex, perioperative pathway and are well placed to identify areas of care requiring investigation in randomized controlled trials. Yet, currently, the scope of nurse-led randomized controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomized controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation. METHODS This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014-19. Sources of unpublished literature included Open Grey, and ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklists for randomized controlled trials. Data were synthesized according to the main objectives. Key information was tabulated. RESULTS From the 86 included studies, key areas where nurses have led randomized controlled trials include patient or caregiver anxiety; postoperative pain relief; surgical site infection prevention: patient and caregiver knowledge; perioperative hypothermia prevention; postoperative nausea and vomiting; in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomization), and gaps for future investigation (including a focus on vulnerable populations), are evident. CONCLUSION Nurse-led randomized controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet, opportunities exist for nurses to lead experimental research in other perioperative priority areas and within different populations that have been neglected, such as in the population of older adults undergoing surgery.
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Affiliation(s)
- Judy Munday
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Department of Health and Nursing Science, University of Agder, Grimstad, 4879, Norway
- Mater Research Institute-UQ, South Brisbane, QLD4101, Australia
| | - Niall Higgins
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Saira Mathew
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Lizanne Dalgleish
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Anthony S Batterbury
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Luke Burgess
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Mater Research Institute-UQ, South Brisbane, QLD4101, Australia
| | - Jill Campbell
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Lori J Delaney
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Colleges of Health and Medicine, Australian National University, Acton, ACT2601, Australia
| | - Bronwyn R Griffin
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - James A Hughes
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
| | - Jessica Ingleman
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, 4111, Australia
| | - Fiona Coyer
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD4029, Australia
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Mitton C, Dionne F. Priority setting and resource allocation in the US health system: is there a place for hard caps? J Health Organ Manag 2020; ahead-of-print. [DOI: 10.1108/jhom-01-2020-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe United States devotes a larger share of its GDP to health care and spends more on health care per capita than any other country. The sheer size of the total spending on health care, at approximately $3.5 trillion in 2017, puts significant pressure on all payers and crowds out other forms of public and private spending.Design/methodology/approachIn this brief commentary the authors suggest that, as part of the effort to deal with this pressure, the United States should look at borrowing a cost containment strategy from other countries: the use of hard caps on spending growth. The authors draw on our their experience of working with decision-makers over the last 20 years on the topic of priority setting to put forward some ideas on whether there is potential for application of trade-offs in the United States.FindingsAs hard caps force choices to be made, a necessary condition for successful implementation of this policy is the presence of an effective priority-setting framework to ensure that the right choices are made in operationalizing spending limitations. Work on this topic elsewhere can provide some insight into the use of a criteria-based framework for priority setting that purports transparency in decision-making to achieve value-based decisions.Originality/valueOther countries still have much work to do, but there is a substantial track record of using formal priority-setting approaches that could potentially inform practice in the United States. We suggest that there are key segments of the US healthcare system where the adoption of formal priority-setting frameworks to guide trade-off decisions is feasible. Piloting such activity in these contexts is the next natural step in this line of inquiry.
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Stratil JM, Baltussen R, Scheel I, Nacken A, Rehfuess EA. Development of the WHO-INTEGRATE evidence-to-decision framework: an overview of systematic reviews of decision criteria for health decision-making. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:8. [PMID: 32071560 PMCID: PMC7014604 DOI: 10.1186/s12962-020-0203-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background 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. Methods 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. criteria), second-level (i.e. sub-criteria) and third-level (i.e. decision aspects) categories. First-level categories were developed a priori using a normative approach; second- and third-level categories were developed inductively. Results 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 criteria, 45 sub-criteria and 200 decision aspects. 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”. Conclusion 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.
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Affiliation(s)
- J M Stratil
- 1Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - R Baltussen
- 2Department for Health Evidence, Radboud University Medical Center, P.O.Box 9101, 6500 HB Nijmegen, The Netherlands
| | - I Scheel
- 3Department of Global Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - A Nacken
- 1Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - E A Rehfuess
- 1Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Zhang W, Mohammadi T, Sou J, Anis AH. Cost-effectiveness of prenatal screening and diagnostic strategies for Down syndrome: A microsimulation modeling analysis. PLoS One 2019; 14:e0225281. [PMID: 31800591 PMCID: PMC6892535 DOI: 10.1371/journal.pone.0225281] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/31/2019] [Indexed: 01/07/2023] Open
Abstract
Objectives Down syndrome (DS) is the most frequently occurring fetal chromosomal abnormality and different prenatal screening strategies are used for determining risk of DS worldwide. New non-invasive prenatal testing (NIPT), which uses cell-free fetal DNA in maternal blood can provide benefits due to its higher sensitivity and specificity in comparison to conventional screening tests. This study aimed to assess the cost-effectiveness of using population-level NIPT in fetal aneuploidy screening for DS. Methods We developed a microsimulation decision-analytic model to perform a probabilistic cost-effectiveness analysis (CEA) of prenatal screening and diagnostic strategies for DS. The model followed individual simulated pregnant women through the pregnancy pathway. The comparators were serum-only screening, contingent NIPT (i.e., NIPT as a second-tier screening test) and universal NIPT (i.e., NIPT as a first-tier screening test). To address uncertainty around the model parameters, the expected values of costs and quality-adjusted life-years (QALYs) in the base case and all scenario analyses were obtained through probabilistic analysis from a Monte Carlo simulation. Results Base case and scenario analyses were conducted by repeating the micro-simulation 1,000 times for a sample of 45,605 pregnant women per the population of British Columbia, Canada (N = 4.8 million). Preliminary results of the sequential CEAs showed that contingent NIPT was a dominant strategy compared to serum-only screening. Compared with contingent NIPT, universal NIPT at the current test price was not cost-effective with an incremental cost-effectiveness ratio over $100,000/QALY. Contingent NIPT also had the lowest cost per DS case detected among these three strategies. Conclusion Including NIPT in existing prenatal screening for DS is shown to be beneficial over conventional testing. However, at current prices, implementation of NIPT as a second-tier screening test is more cost-effective than deploying it as a universal test.
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Affiliation(s)
- Wei Zhang
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tima Mohammadi
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Julie Sou
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Aslam H. Anis
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Holmes RD, Steele JG, Exley C, Vernazza CR, Donaldson C. Use of programme budgeting and marginal analysis to set priorities for local NHS dental services: learning from the north east of England. J Public Health (Oxf) 2019; 40:e578-e585. [PMID: 29726998 DOI: 10.1093/pubmed/fdy075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/13/2018] [Indexed: 11/12/2022] Open
Abstract
Background Priority setting is necessary where competing demands exceed the finite resources available. The aim of the study was to develop and test a prioritization framework based upon programme budgeting and marginal analysis (PBMA) as a tool to assist National Health Service (NHS) commissioners in their management of resources for local NHS dental services. Methods Twenty-seven stakeholders (5 dentists, 8 commissioners and 14 patients) participated in a case-study based in a former NHS commissioning organization in the north of England. Stakeholders modified local decision-making criteria and applied them to a number of different scenarios. Results The majority of financial resources for NHS dental services in the commissioning organization studied were allocated to primary care dental practitioners' contracts in perpetuity, potentially constraining commissioners' abilities to shift resources. Compiling the programme budget was successful, but organizational flux and difficulties engaging local NHS commissioners significantly impacted upon the marginal analysis phase. Conclusions NHS dental practitioners' contracts resemble budget-silos which do not facilitate local resource reallocation. 'Context-specific' factors significantly challenged the successful implementation and impact of PBMA. A local PBMA champion embedded within commissioning organizations should be considered. Participants found visual depiction of the cost-value ratio helpful during their initial priority setting deliberations.
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Affiliation(s)
- R D Holmes
- Centre for Oral Health Research, Newcastle University, School of Dental Sciences, Framlington Place, Newcastle upon Tyne, UK
| | - J G Steele
- Centre for Oral Health Research, Newcastle University, School of Dental Sciences, Framlington Place, Newcastle upon Tyne, UK
| | - C Exley
- Faculty of Health and Life Sciences, Northumbria University, Northumberland Building, Newcastle upon Tyne, UK
| | - C R Vernazza
- Centre for Oral Health Research, Newcastle University, School of Dental Sciences, Framlington Place, Newcastle upon Tyne, UK
| | - C Donaldson
- Yunus Centre for Social Business & Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
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Oliveira MD, Mataloto I, Kanavos P. Multi-criteria decision analysis for health technology assessment: addressing methodological challenges to improve the state of the art. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:891-918. [PMID: 31006056 PMCID: PMC6652169 DOI: 10.1007/s10198-019-01052-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/14/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Multi-criteria decision analysis (MCDA) concepts, models and tools have been used increasingly in health technology assessment (HTA), with several studies pointing out practical and theoretical issues related to its use. This study provides a critical review of published studies on MCDA in the context of HTA by assessing their methodological quality and summarising methodological challenges. METHODS A systematic review was conducted to identify studies discussing, developing or reviewing the use of MCDA in HTA using aggregation approaches. Studies were classified according to publication time and type, country of study, technology type and study type. The PROACTIVE-S approach was constructed and used to analyse methodological quality. Challenges and limitations reported in eligible studies were collected and summarised; this was followed by a critical discussion on research requirements to address the identified challenges. RESULTS 129 journal articles were eligible for review, 56% of which were published in 2015-2017; 42% focused on pharmaceuticals; 36, 26 and 18% reported model applications, issues regarding MCDA implementation analyses, and proposing frameworks, respectively. Poor compliance with good methodological practice (< 25% complying studies) was found regarding behavioural analyses, discussion of model assumptions and uncertainties, modelling of value functions, and dealing with judgment inconsistencies. The five most reported challenges related to evidence and data synthesis; value system differences and participant selection issues; participant difficulties; methodological complexity and resource balance; and criteria and attributes modelling. A critical discussion on ways to address these challenges ensues. DISCUSSION Results highlight the need for advancement in robust methodologies, procedures and tools to improve methodological quality of MCDA in HTA studies. Research pathways include developing new model features, good practice guidelines, technologies to enable participation and behavioural research.
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Affiliation(s)
- Mónica D Oliveira
- CEG-IST, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal.
| | - Inês Mataloto
- CEG-IST, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Panos Kanavos
- Department of Health Policy and Medical Technology Research Group, LSE Health London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Tal O, Booch M, Bar-Yehuda S. Hospital staff perspectives towards health technology assessment: data from a multidisciplinary survey. Health Res Policy Syst 2019; 17:72. [PMID: 31337398 PMCID: PMC6651984 DOI: 10.1186/s12961-019-0469-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 06/10/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Technology adoption in hospitals is usually based on cost-effectiveness analysis, feasibility and potential success. Different countries have embraced a range of principles to accomplish an effective comprehensive process of health technology assessment (HTA). The aim of the study was to analyse the viewpoints and relative weight of technology-oriented hospital staff members toward the clinical, social, technological and economic aspects of HTA. METHODS Using a structured questionnaire, a survey was conducted among different professionals in an 850-bed hospital. RESULTS We revealed a range of viewpoints among hospital staff members according to their personal characteristics and professional standpoints. The clinical aspects of HTA were considered 'highly important' (HI) by most participants, especially the 'lifesaving' parameter. Similarly, the 'lack of effective alternative technology' was ranked HI by a high percentage of participants, independent of their profession. Economic aspects were ranked HI only by half of the participants, while social and technological aspects were ranked HI only by a relatively low percentage. Nurses added 'improving quality of life', 'increasing teamwork efficiency' and 'improving medical standards'. Allied health professionals focused on 'lack of effective alternative technologies' as a main argument for adoption of HTA, alongside increasing efficiency, budget savings and contribution to hospital reputation. Engineers emphasised the requirement of significant investment in infrastructure and increasing efficiency. Administrators ranked patient experience as HI. Interestingly, the high ranking of social aspects correlated with older responders, while junior staff ranked safety significantly higher. CONCLUSIONS A multi-perspective multidisciplinary approach would be beneficial for policy-makers at hospitals and even on a national scale in Israel.
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Affiliation(s)
- Orna Tal
- Shamir Medical Center (Assaf Harofeh), 70300, Zerifin, Israel.
- ICET - Israeli Center for Emerging Technologies, Zerifin, Israel.
| | - Meirav Booch
- Shamir Medical Center (Assaf Harofeh), 70300, Zerifin, Israel
- ICET - Israeli Center for Emerging Technologies, Zerifin, Israel
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Enhancing Equitable Access to Assistive Technologies in Canada: Insights from Citizens and Stakeholders. Can J Aging 2019; 39:69-88. [DOI: 10.1017/s0714980819000187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
RÉSUMÉLes besoins en technologies d’assistance augmentent au Canada, mais l’accès à ces technologies est inégal et fragmentaire, ce qui ferait en sorte que des besoins demeureraient non comblés. Cette étude visait à identifier les valeurs et préférences des citoyens concernant les moyens à utiliser pour favoriser un accès équitable aux technologies d’assistance. Elle visait également à impliquer les décideurs politiques, les parties prenantes et les chercheurs dans des discussions afin d’élaborer des actions dans ce domaine. Au printemps 2017, nous avons organisé trois panels de citoyens et un dialogue avec les parties prenantes. Les principales conclusions des panels ont été incluses dans une synthèse qui a été partagée avec les participants du dialogue. Trente-sept citoyens ont participé aux panels et ont souligné l’importance de l’accès à de l’information fiable, d’un accès équitable aux technologies d’assistance (et ce, quelle que soit la capacité de payer), et de la collaboration. Les vingt-deux participants au dialogue ont fait valoir la nécessité d’un cadre d’orientation pour appuyer l’évolution des pratiques dans l’ensemble au pays. Le cadre d’orientation proposé combinerait des politiques et programmes simplifiés incluant la collecte et l’évaluation de données robustes pour appuyer l’innovation et l’imputabilité à travers le pays.
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Rehfuess EA, Stratil JM, Scheel IB, Portela A, Norris SL, Baltussen R. The WHO-INTEGRATE evidence to decision framework version 1.0: integrating WHO norms and values and a complexity perspective. BMJ Glob Health 2019; 4:e000844. [PMID: 30775012 PMCID: PMC6350705 DOI: 10.1136/bmjgh-2018-000844] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/05/2018] [Accepted: 07/20/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Evidence-to-decision (EtD) frameworks intend to ensure that all criteria of relevance to a health decision are systematically considered. This paper, part of a series commissioned by the WHO, reports on the development of an EtD framework that is rooted in WHO norms and values, reflective of the changing global health landscape, and suitable for a range of interventions and complexity features. We also sought to assess the value of this framework to decision-makers at global and national levels, and to facilitate uptake through suggestions on how to prioritise criteria and methods to collect evidence. METHODS In an iterative, principles-based approach, we developed the framework structure from WHO norms and values. Preliminary criteria were derived from key documents and supplemented with comprehensive subcriteria obtained through an overview of systematic reviews of criteria employed in health decision-making. We assessed to what extent the framework can accommodate features of complexity, and conducted key informant interviews among WHO guideline developers. Suggestions on methods were drawn from the literature and expert consultation. RESULTS The new WHO-INTEGRATE (INTEGRATe Evidence) framework comprises six substantive criteria-balance of health benefits and harms, human rights and sociocultural acceptability, health equity, equality and non-discrimination, societal implications, financial and economic considerations, and feasibility and health system considerations-and the meta-criterion quality of evidence. It is intended to facilitate a structured process of reflection and discussion in a problem-specific and context-specific manner from the start of a guideline development or other health decision-making process. For each criterion, the framework offers a definition, subcriteria and example questions; it also suggests relevant primary research and evidence synthesis methods and approaches to assessing quality of evidence. CONCLUSION The framework is deliberately labelled version 1.0. We expect further modifications based on focus group discussions in four countries, example applications and input across concerned disciplines.
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Affiliation(s)
- Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Inger B Scheel
- Department of Global Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Susan L Norris
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Rob Baltussen
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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Busert LK, Mütsch M, Kien C, Flatz A, Griebler U, Wildner M, Stratil JM, Rehfuess EA. Facilitating evidence uptake: development and user testing of a systematic review summary format to inform public health decision-making in German-speaking countries. Health Res Policy Syst 2018; 16:59. [PMID: 29986706 PMCID: PMC6038322 DOI: 10.1186/s12961-018-0307-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/02/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Systematic reviews are an important source of evidence for public health decision-making, but length and technical jargon tend to hinder their use. In non-English speaking countries, inaccessibility of information in the native language often represents an additional barrier. In line with our vision to strengthen evidence-based public health in the German-speaking world, we developed a German language summary format for systematic reviews of public health interventions and undertook user-testing with public health decision-makers in Germany, Austria and Switzerland. METHODS We used several guiding principles and core elements identified from the literature to produce a prototype summary format and applied it to a Cochrane review on the impacts of changing portion and package sizes on selection and consumption of food, alcohol and tobacco. Following a pre-test in each of the three countries, we carried out 18 user tests with public health decision-makers in Germany, Austria and Switzerland using the 'think-aloud' method. We analysed participants' comments according to the facets credibility, usability, understandability, usefulness, desirability, findability, identification and accessibility. We also identified elements that hindered the facile and satisfying use of the summary format, and revised it based on participants' feedback. RESULTS The summary format was well-received; participants particularly appreciated receiving information in their own language. They generally found the summary format useful and a credible source of information, but also signalled several barriers to a positive user experience such as an information-dense structure and difficulties with understanding statistical terms. Many of the identified challenges were addressed through modifications of the summary format, in particular by allowing for flexible length, placing more emphasis on key messages and relevance for public health practice, expanding the interpretation aid for statistical findings, providing a glossary of technical terms, and only including graphical GRADE ratings. Some barriers to uptake, notably the participants' wish for actionable recommendations and contextual information, could not be addressed. CONCLUSIONS Participants welcomed the initiative, but user tests also revealed their problems with understanding and interpreting the findings summarised in our prototype format. The revised summary format will be used to communicate the results of Cochrane reviews of public health interventions.
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Affiliation(s)
- Laura K. Busert
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Margot Mütsch
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Christina Kien
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Aline Flatz
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Ursula Griebler
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Manfred Wildner
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Jan M. Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Eva A. Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - on behalf of Cochrane Public Health Europe
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Route de la Corniche 10, 1010 Lausanne, Switzerland
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Wong JQ, Uy J, Haw NJL, Valdes JX, Bayani DBS, Bautista CAP, Haasis MA, Bermejo RA, Zeck W. Priority Setting for Health Service Coverage Decisions Supported by Public Spending: Experience from the Philippines. Health Syst Reform 2017. [DOI: 10.1080/23288604.2017.1368432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Jhanna Uy
- EpiMetrics, Inc., Parañaque City, Philippines
| | | | | | | | - Charl Andrew P. Bautista
- Health Policy Development and Planning Bureau, Department of Health, Santa Cruz, Manila, Philippines
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Hoekstra D, Mütsch M, Kien C, Gerhardus A, Lhachimi SK. Identifying and prioritising systematic review topics with public health stakeholders: A protocol for a modified Delphi study in Switzerland to inform future research agendas. BMJ Open 2017; 7:e015500. [PMID: 28780546 PMCID: PMC5724103 DOI: 10.1136/bmjopen-2016-015500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The Cochrane Collaboration aims to produce relevant and top priority evidence that responds to existing evidence gaps. Hence, research priority setting (RPS) is important to identify which potential research gaps are deemed most important. Moreover, RPS supports future health research to conform both health and health evidence needs. However, studies that are prioritising systematic review topics in public health are surprisingly rare. Therefore, to inform the research agenda of Cochrane Public Health Europe (CPHE), we introduce the protocol of a priority setting study on systematic review topics in several European countries, which is conceptualised as pilot. METHODS AND ANALYSIS We will conduct a two-round modified Delphi study in Switzerland, incorporating an anonymous web-based questionnaire, to assess which topics should be prioritised for systematic reviews in public health. In the first Delphi round public health stakeholders will suggest relevant assessment criteria and potential priority topics. In the second Delphi round the participants indicate their (dis)agreement to the aggregated results of the first round and rate the potential review topics with the predetermined criteria on a four-point Likert scale. As we invite a wide variety of stakeholders we will compare the results between the different stakeholder groups. ETHICS AND DISSEMINATION We have received ethical approval from the ethical board of the University of Bremen, Germany (principal investigation is conducted at the University of Bremen) and a certificate of non-objection from the Canton of Zurich, Switzerland (fieldwork will be conducted in Switzerland). The results of this study will be further disseminated through peer reviewed publication and will support systematic review author groups (i.a. CPHE) to improve the relevance of the groups´ future review work. Finally, the proposed priority setting study can be used as a framework by other systematic review groups when conducting a priority setting study in a different context.
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Affiliation(s)
- Dyon Hoekstra
- Research Group for Evidence-Based Public Health, Leibniz-Institute for Prevention Research and Epidemiology (BIPS) & Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Margot Mütsch
- Department of Epidemiology, Biostatistics and Prevention Institute, Institute University of Zurich, Zurich, Switzerland
| | - Christina Kien
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria
| | - Ansgar Gerhardus
- Department for Health Services Research, Institute for Public Health and Nursing Research (IPP), University Bremen, Bremen, Germany
| | - Stefan K Lhachimi
- Research Group for Evidence-Based Public Health, Leibniz-Institute for Prevention Research and Epidemiology (BIPS), Institute for Public Health and Nursing Research (IPP), Health Sciences, University of Bremen, Bremen, Germany
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The bare necessities? A realist review of necessity argumentations used in health care coverage decisions. Health Policy 2017; 121:731-744. [PMID: 28550936 DOI: 10.1016/j.healthpol.2017.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 12/11/2022]
Abstract
CONTEXT Policy makers and insurance companies decide on coverage of care by both calculating (cost-) effectiveness and assessing the necessity of coverage. AIM To investigate argumentations pertaining to necessity used in coverage decisions made by policy makers and insurance companies, as well as those argumentations used by patients, authors, the public and the media. METHODS This study is designed as a realist review, adhering to the RAMESES quality standards. Embase, Medline and Web of Science were searched and 98 articles were included that detailed necessity-based argumentations. RESULTS We identified twenty necessity-based argumentation types. Seven are only used to argue in favour of coverage, five solely for arguing against coverage, and eight are used to argue both ways. A positive decision appears to be facilitated when patients or the public set the decision on the agenda. Moreover, half the argumentation types are only used by patients, authors, the public and the media, whereas the other half is also used by policy makers and insurance companies. The latter group is more accepted and used in more different countries. CONCLUSION The majority of necessity-based argumentation types is used for either favouring or opposing coverage, and not for both. Patients, authors, the public and the media use a broader repertoire of argumentation types than policy makers and insurance companies.
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Yazdani S, Jadidfard MP. Developing a decision support system to link health technology assessment (HTA) reports to the health system policies in Iran. Health Policy Plan 2017; 32:504-515. [PMID: 28025325 DOI: 10.1093/heapol/czw160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 01/08/2023] Open
Abstract
The recent increase of 'Health Technology Assessment' (HTA)-related activities in Iran has necessitated the clarification of policy-making process based on the HTA reports. This study aimed to develop a Decision Support System (DSS) in order to adopt evidence-informed policies regarding health technologies in Iran. The study can be classified as Health Policy and Systems Research. A core panel of seven experts conducted two separate reviews of relevant literature for: 1- Determining the potential technology-related policies. 2- Listing the criteria influencing those policy decisions. The policies and criteria were separately discussed and subsequently rated for appropriateness and necessity during two expert meetings in 2013. In the next step, The 'Discrete Choice Experiment' (DCE) method was employed to develop the DSS for the final technology-related policies. Accordingly, the core panel members independently rated the appropriateness of each policy for 30 virtual technologies based on the random values assigned to all the criteria for each technology. The obtained data for each policy were separately analysed using stepwise regression model, resulting in a minimal set of independent and statistically significant criteria contributing in the experts' judgments about the appropriateness of that policy. The obtained regression coefficients were used as the relative weights of the different levels of the final criteria of any policy statement, shaping the decision support scoring tool for each policy. The study has outlined 64 policy decisions under 7 macro policy areas concerning a health technology. Also, 34 criteria used for making those policy decisions have been organized within a portfolio. DCE, using stepwise regression, resulted in 64 scoring tools shaping the DSS for all HTA-related policies. Both the results and methodology of the study may serve as a guide for policy makers (researchers), particularly in low and middle income countries, in developing decision aids for their own context-specific HTA-related policies.
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Affiliation(s)
- Shahram Yazdani
- Dean of School of Medical Education, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Pooyan Jadidfard
- Department of Community Oral Health, School of Dentistry, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
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Kwon SH, Park SK, Byun JH, Lee EK. Eliciting societal preferences of reimbursement decision criteria for anti cancer drugs in South Korea. Expert Rev Pharmacoecon Outcomes Res 2017; 17:411-419. [PMID: 28019130 DOI: 10.1080/14737167.2017.1277144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In order to look beyond the cost-effectiveness analysis, this study used a multi-criteria decision analysis (MCDA), which reflects societal values with regard to reimbursement decisions. This study aims to elicit societal preferences of the reimbursement decision criteria for anti cancer drugs from public and healthcare professionals. METHODS Eight criteria were defined based on a literature review and focus group sessions: disease severity, disease population size, pediatrics targets, unmet needs, innovation, clinical benefits, cost-effectiveness, and budget impacts. Using quota sampling and purposive sampling, 300 participants from the Korean public and 30 healthcare professionals were selected for the survey. Preferences were elicited using an analytic hierarchy process. RESULTS Both groups rated clinical benefits the highest, followed by cost-effectiveness and disease severity, but differed with regard to disease population size and unmet needs. Innovation was the least preferred criteria. CONCLUSIONS Clinical benefits and other social values should be reflected appropriately with cost-effectiveness in healthcare coverage. MCDA can be used to assess decision priorities for complicated health policy decisions, including reimbursement decisions. It is a promising method for making logical and transparent drug reimbursement decisions that consider a broad range of factors, which are perceived as important by relevant stakeholders.
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Affiliation(s)
- Sun-Hong Kwon
- a School of Pharmacy , Sungkyunkwan University , Suwon , South Korea
| | - Sun-Kyeong Park
- a School of Pharmacy , Sungkyunkwan University , Suwon , South Korea
| | - Ji-Hye Byun
- a School of Pharmacy , Sungkyunkwan University , Suwon , South Korea
| | - Eui-Kyung Lee
- a School of Pharmacy , Sungkyunkwan University , Suwon , South Korea
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Abelson J, Allin S, Grignon M, Pasic D, Walli-Attaei M. Uncomfortable trade-offs: Canadian policy makers' perspectives on setting objectives for their health systems. Health Policy 2016; 121:9-16. [PMID: 27894606 DOI: 10.1016/j.healthpol.2016.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 09/19/2016] [Accepted: 10/14/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although a wide range of health system performance indicators are commonly reported on, there has been little effort to establish their relevance to the objectives that health systems actually pursue. OBJECTIVE The aim of this study was to identify, explore and better understand health policy makers' views regarding the objectives and outcomes for their health systems, how they are prioritized, and the underlying processes that yield them to inform the development of health system efficiency measures. METHODS A descriptive, qualitative methodology was employed using key informant interviews with 17 current and former senior health ministry officials in 8 Canadian provinces and 2 territories. KEY FINDINGS Health ministries have clearly stated objectives for health systems focused on the achievement of health system delivery and population health goals and, increasingly, public, patient and financial accountability. Acute care objectives are routinely prioritized over population health objectives and viewed as resulting from challenges associated with difficult trade-off decisions shaped by organized interests and the media rather than explicit, evidence-based processes. CONCLUSION This study provides insights beyond publicly available documents to explore the processes that underlie simple statements of health system objectives. Our findings suggest that despite respondents giving priority to improving individual and population health, it is more commonly portrayed as an ideal objective than as a realistic one. By understanding what lies behind statements about what health systems are striving for, we offer a more robust avenue for increasing the uptake of future studies of health system performance.
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Affiliation(s)
- Julia Abelson
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario L8S 4K1, Canada.
| | - Sara Allin
- Canadian Institute for Health Information, 4110 Yonge Street, Suite 300, Toronto, Ontario M2P 2B7, Canada.
| | - Michel Grignon
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Department of Economics, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Hamilton Ontario L8S 4K1, Canada.
| | - Dianna Pasic
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Marjan Walli-Attaei
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Health Policy PhD Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada.
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Smith N, Mitton C, Hiltz MA, Campbell M, Dowling L, Magee JF, Gujar SA. A Qualitative Evaluation of Program Budgeting and Marginal Analysis in a Canadian Pediatric Tertiary Care Institution. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:559-568. [PMID: 27289589 DOI: 10.1007/s40258-016-0250-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Hospitals in Canada are being asked by governments to improve efficiency and do more with fewer resources. Healthcare decision makers are thus driven to find better ways to manage budgets and deliver on their mission. Formal processes of priority setting and resource allocation (PSRA) are one means to this end. OBJECTIVE This paper reports an evaluation of one such approach, Program Budgeting and Marginal Analysis (PBMA), as applied at a children and women's tertiary care facility in Nova Scotia, Canada. A brief evaluation conducted immediately after the conclusion of the PBMA process was supplemented with a larger retrospective evaluation. METHODS The retrospective evaluation included 26 face-to-face individual interviews with senior and middle managers who took part in PBMA. Interview transcripts were analyzed against a template consisting of 19 elements of structure, process, attitudes, and outcomes associated with high performance in PSRA. RESULTS Respondents had a good experience with the implementation of PBMA, and considered it an improvement over past practice. Success was attributed to effective leadership, and substantial efforts to engage staff members. Understanding of economic and ethical principles of decision making was reportedly increased. Areas for improvement included ensuring that everyone participated in good faith, better communication of final results, and stronger follow-through to determine if anticipated changes and benefits in fact occurred. CONCLUSION The evaluation framework employed here proved useful in assessing the quality of this resource allocation exercise. The results are directly useful to local decision makers, and the identified strengths and weaknesses are broadly consistent with those reported in studies of other organizations.
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Affiliation(s)
- Neale Smith
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, 7th floor, 828 W 10th Avenue, Vancouver, BC, V5Z1M9, Canada.
| | - Craig Mitton
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, 7th floor, 828 W 10th Avenue, Vancouver, BC, V5Z1M9, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, V5Z1M9, Canada
| | - Mary-Ann Hiltz
- Quality and System Performance, IWK Health Centre, Halifax, NS, B3K6R8, Canada
| | - Matthew Campbell
- Quality and System Performance, IWK Health Centre, Halifax, NS, B3K6R8, Canada
| | - Laura Dowling
- Nova Scotia Health Authority, Halifax, NS, B3H1V7, Canada
| | - J Fergall Magee
- Pathology and Laboratory Medicine, University of Saskatchewan and Saskatoon Health Region, 103 Hospital Dr, Saskatoon, Sk, SK S7N0W8, Canada
| | - Shashi Ashok Gujar
- Quality and System Performance, IWK Health Centre, Halifax, NS, B3K6R8, Canada
- Faculty of Medicine, Dalhousie University, Halifax, NS, B3H1X5, Canada
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McGregor D, Rankin N, Butow P, York S, White K, Phillips J, Stone E, Barnes D, Jones R, Shaw T. Closing evidence-practice gaps in lung cancer: Results from multi-methods priority setting in the clinical context. Asia Pac J Clin Oncol 2016; 13:28-36. [DOI: 10.1111/ajco.12499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/02/2016] [Accepted: 04/05/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Deborah McGregor
- RISE Faculty of Health Sciences; University of Sydney; New South Wales Australia
| | - Nicole Rankin
- Sydney Catalyst Translational Cancer Centre; University of Sydney; New South Wales Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG), and School of Psychology; University of Sydney; New South Wales Australia
| | - Sarah York
- Sydney Catalyst Translational Cancer Centre; University of Sydney; New South Wales Australia
| | - Kate White
- Cancer Nursing Research Unit; University of Sydney, and Sydney Local Health District; New South Wales Australia
| | - Jane Phillips
- Centre for Cardiovascular and Chronic Care; University of Technology Sydney; New South Wales Australia
| | - Emily Stone
- Department of Thoracic Medicine; St Vincent's Hospital; Darlinghurst New South Wales Australia
| | - David Barnes
- Department of Respiratory and Sleep Medicine; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Ruth Jones
- Western New South Wales Local Health District; Dubbo New South Wales Australia
| | - Tim Shaw
- RISE Faculty of Health Sciences; University of Sydney; New South Wales Australia
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Parrella A, Braunack-Mayer A, Collins J, Clarke M, Tooher R, Ratcliffe J, Marshall H. Prioritizing government funding of adolescent vaccinations: recommendations from young people on a citizens' jury. Vaccine 2016; 34:3592-7. [PMID: 27195757 DOI: 10.1016/j.vaccine.2016.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/04/2016] [Accepted: 05/08/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adolescents' views, and preferences are often over-looked when public health policies that affect them are designed and implemented. The purpose of this study was to describe young people's views and preferences for determining government funding priorities for adolescent immunization programs. METHODS In 2015 we conducted a youth jury in metropolitan Adelaide, South Australia to deliberate on the question "What criteria should we use to decide which vaccines for young people in Australia should receive public funding?" Fifteen youth aged 15-19 years participated in the jury. Jury members were recruited from the general community through a market research company using a stratified sampling technique. RESULTS The jury's key priorities for determining publically funded vaccines were: Disease severity - whether the vaccine preventable disease (VPD) was life threatening and impacted on quality of life. Transmissibility - VPDs with high/fast transmission and high prevalence. Demonstration of cost-effectiveness, taking into account purchase price, program administration, economic and societal gain. The jury's recommendations for vaccine funding policy were strongly underpinned by the belief that it was critical to ensure that funding was targeted to not only population groups who would be medically at risk from vaccine preventable diseases, but also to socially and economically disadvantaged population groups. A novel recommendation proposed by the jury was that there should be a process for establishing criteria to remove vaccines from publically funded programs as a complement to the process for adding new vaccines. CONCLUSIONS Young people have valuable contributions to make in priority setting for health programs and their views should be incorporated into the framing of health policies that directly affect them.
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Affiliation(s)
- Adriana Parrella
- Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Annette Braunack-Mayer
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Joanne Collins
- Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Michelle Clarke
- Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Rebecca Tooher
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Julie Ratcliffe
- Flinders Health Economics Group, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, Adelaide, South Australia 5041, Australia.
| | - Helen Marshall
- Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
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Assessment of Vaccination Strategies Using Fuzzy Multi-criteria Decision Making. ADVANCES IN INTELLIGENT SYSTEMS AND COMPUTING 2015. [DOI: 10.1007/978-3-319-27212-2_16] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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