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Oortwijn W, van Oosterhout S, Kapiriri L. Application of evidence-informed deliberative processes in health technology assessment in low- and middle-income countries. Int J Technol Assess Health Care 2020; 36:1-5. [PMID: 32715993 DOI: 10.1017/s0266462320000549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Evidence-informed deliberative processes (EDPs) were introduced to guide health technology assessment (HTA) agencies to improve their processes toward more legitimate decision making. A survey among members of the International Network of Agencies for HTA (INAHTA) showed that EDPs can also be relevant for countries that have not (yet) established such an agency. Therefore, we explored to what extent low- and middle-income countries (LMIC) applied the steps and elements stipulated in the EDP framework and their need for guidance. METHODS The survey among INAHTA members was slightly adapted to address LMIC context and sent to 416 experts identified through several HTA sources. The questions focused on contextual factors and the EDP steps (installation of an appraisal committee, selecting technologies and criteria, assessment, appraisal, communication and appeal). Data collection took place between 21 May and 1 September 2019. Descriptive statistics and qualitative analyses were used to summarize the findings. RESULTS We received sixty-six meaningful responses from experts in thirty-two LMIC. We found that contextual factors to support HTA development are overall not present or only present to some extent. Respondents indicated that guidance was needed for specific elements related to selecting technologies and criteria, assessment, appraisal, as well as communication and appeal. CONCLUSIONS EDPs have the potential to provide steps for improving HTA processes. The results of this study can serve as a baseline measurement for future monitoring and evaluation of EDP application in the responding LMIC. This could support the countries in improving their processes and enhancing legitimate decision making when using HTA.
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Affiliation(s)
- Wija Oortwijn
- Department for Health Evidence, Radboud University Medical Centre, P.O. Box 9101, 6500 HBNijmegen, The Netherlands
| | - Sanne van Oosterhout
- Department for Health Evidence, Radboud University Medical Centre, P.O. Box 9101, 6500 HBNijmegen, The Netherlands
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Main Street West 1280, Hamilton, ON, Canada
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Kapiriri L, Baltussen R, Oortwijn W. Implementing evidence-informed deliberative processes in health technology assessment: a low income country perspective. Int J Technol Assess Health Care 2020; 36:29-33. [PMID: 31944173 DOI: 10.1017/S0266462319003398] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this paper is to discuss the potential feasibility and utility of evidence-informed deliberative processes (EPDs) in low income country (LIC) contexts. EDPs are implemented in high and middle income countries and thought to improve the quality, consistency, and transparency of decisions informed by health technology assessment (HTA). Together these would ultimately improve the legitimacy of any decision making process. We argue-based on our previous work and in light of the priority setting literature-that EDPs are relevant and feasible within LICs. The extreme lack of resources necessitates making tough decisions which may mean depriving populations of potentially valuable health technologies. It is critical that the decisions and the decision making bodies are perceived as fair and legitimate by the people that are most affected by the decisions. EDPs are well aligned with the political infrastructure in some LICs, which encourages public participation in decision making. Furthermore, many countries are committed to evidence-informed decision making. However, the application of EDPs may be hampered by the limited availability of evidence of good quality, lack of interest in transparency and accountability (in some LICs), limited capacity to conduct HTA, as well as limited time and financial resources to invest in a deliberative process. While EDPs would potentially benefit many LICs, mitigating the identified potential barriers would strengthen their applicability. We believe that implementation studies in LICs, documenting the contextualized enablers and barriers will facilitate the development of context specific improvement strategies for EDPs.
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Tromp N, Prawiranegara R, Siregar A, Wisaksana R, Pinxten L, Pinxten J, Lesmana Putra A, Kurnia Sunjaya D, Jansen M, Hontelez J, Maurits S, Maharani F, Bijlmakers L, Baltussen R. Translating international HIV treatment guidelines into local priorities in Indonesia. Trop Med Int Health 2018; 23:279-294. [PMID: 29327397 DOI: 10.1111/tmi.13031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE International guidelines recommend countries to expand antiretroviral therapy (ART) to all HIV-infected individuals and establish local-level priorities in relation to other treatment, prevention and mitigation interventions through fair processes. However, no practical guidance is provided for such priority-setting processes. Evidence-informed deliberative processes (EDPs) fill this gap and combine stakeholder deliberation to incorporate relevant social values with rational decision-making informed by evidence on these values. This study reports on the first-time implementation and evaluation of an EDP in HIV control, organised to support the AIDS Commission in West Java province, Indonesia, in the development of its strategic plan for 2014-2018. METHODS Under the responsibility of the provincial AIDS Commission, an EDP was implemented to select priority interventions using six steps: (i) situational analysis; (ii) formation of a multistakeholder Consultation Panel; (iii) selection of criteria; (iv) identification and assessment of interventions' performance; (v) deliberation; and (vi) selection of funding and implementing institutions. An independent researcher conducted in-depth interviews (n = 21) with panel members to evaluate the process. RESULTS The Consultation Panel included 23 stakeholders. They identified 50 interventions and these were evaluated against four criteria: impact on the epidemic, stigma reduction, cost-effectiveness and universal coverage. After a deliberative discussion, the Consultation Panel prioritised a combination of several treatment, prevention and mitigation interventions. CONCLUSION The EDP improved both stakeholder involvement and the evidence base for the strategic planning process. EDPs fill an important gap which international guidelines and current tools for strategic planning in HIV control leave unaddressed.
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Affiliation(s)
- Noor Tromp
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,KIT (Royal Tropical Institute), Amsterdam, The Netherlands
| | - Rozar Prawiranegara
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Adiatma Siregar
- Faculty Economics and Business, Padjadjaran University, Bandung, Indonesia
| | - Rudi Wisaksana
- Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Lucas Pinxten
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Faculty of Psychology and Neuroscience, Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Juul Pinxten
- Social Protection and Jobs Global Practice, World Bank, Jarkarta, Indonesia
| | - Arry Lesmana Putra
- United Nations Development Programme Indonesia, Jakarta, Indonesia.,West Java Provincial AIDS commission, Bandung, Indonesia
| | | | - Maarten Jansen
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Hontelez
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Heidelberg Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Scott Maurits
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Leon Bijlmakers
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob Baltussen
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Baltussen R, Jansen MPM, Bijlmakers L, Grutters J, Kluytmans A, Reuzel RP, Tummers M, der Wilt GJV. Value Assessment Frameworks for HTA Agencies: The Organization of Evidence-Informed Deliberative Processes. Value Health 2017; 20:256-260. [PMID: 28237205 DOI: 10.1016/j.jval.2016.11.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/13/2016] [Accepted: 11/17/2016] [Indexed: 05/09/2023]
Abstract
Priority setting in health care has been long recognized as an intrinsically complex and value-laden process. Yet, health technology assessment agencies (HTAs) presently employ value assessment frameworks that are ill fitted to capture the range and diversity of stakeholder values and thereby risk compromising the legitimacy of their recommendations. We propose "evidence-informed deliberative processes" as an alternative framework with the aim to enhance this legitimacy. This framework integrates two increasingly popular and complementary frameworks for priority setting: multicriteria decision analysis and accountability for reasonableness. Evidence-informed deliberative processes are, on one hand, based on early, continued stakeholder deliberation to learn about the importance of relevant social values. On the other hand, they are based on rational decision-making through evidence-informed evaluation of the identified values. The framework has important implications for how HTA agencies should ideally organize their processes. First, HTA agencies should take the responsibility of organizing stakeholder involvement. Second, agencies are advised to integrate their assessment and appraisal phases, allowing for the timely collection of evidence on values that are considered relevant. Third, HTA agencies should subject their decision-making criteria to public scrutiny. Fourth, agencies are advised to use a checklist of potentially relevant criteria and to provide argumentation for how each criterion affected the recommendation. Fifth, HTA agencies must publish their argumentation and install options for appeal. The framework should not be considered a blueprint for HTA agencies but rather an aspirational goal-agencies can take incremental steps toward achieving this goal.
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Affiliation(s)
- Rob Baltussen
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Leon Bijlmakers
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke Grutters
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anouck Kluytmans
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob P Reuzel
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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