PDF(Pubmed)
Abstract：
Countries fundamentally base macro and micro decision making in the field of health on economic considerations, the budgetary impact of technologies being a major criterion. Nevertheless, the value of the technology of interest and its dimensions are more complex if we seek to take decisions based on the value itself. The use of structured and explicit approaches that require the assessment of multiple criteria that reflect the dimensions of this value may significantly improve the quality of the decision making. Multi-criteria decision analysis (MCDA) is a complementary decision-making tool that is able to systematically incorporate dimensions or domains such as ethical, organisational, legal, environmental and social considerations, as well as costs and benefits of medical interventions, together with the distinct perspectives of the interested parties. The objective of this article is to propose the implementation of analysis of non-core domains, in reports of Health Technology Assessment (HTA) agencies/units. To assess the scientific evidence on MCDA techniques a systematic review was conducted using structured searches in biomedical databases and websites of various HTA organisations. A consensus group was held using the nominal group technique and involving users of healthcare services, providers, managers and academics. Complementary, a survey was sent to HTA agencies to ascertain the degree of implementation of MCDA in their methods. 42 articles reporting the use of non-core criteria for the assessment of health technologies were included in the analysis. From these articles, a total of 216 non-core criteria were retrieved and categorised into domains by the researchers, and of these, 56 were classified as socioeconomic, 59 as organisational, 10 as legal, 8 as environmental and 47 as ethical, while 36 were considered to relate to other domains. The consensus group, based on the 216 non-core criteria obtained from the systematic review, proposed, and defined 26 criteria that participants considered necessary for decision making in healthcare. The consensus group did not consider that any of the domains should be given more weight than others or that any individual criteria should dominate. These approaches can serve as a framework of reference for a well-structured systematic discussion concerning the basis of individual criteria and the evidence supporting them.
摘要：
各国从根本上把卫生领域的宏观和微观决策建立在经济考虑的基础上,技术的预算影响是一个主要标准。然而，如果我们试图根据价值本身做出决定，那么感兴趣的技术的价值及其维度就会更加复杂。使用结构化和明确的方法，需要评估反映此值维度的多个标准，可能会大大提高决策质量。多准则决策分析（MCDA）是一种互补的决策工具，能够系统地纳入诸如道德，组织,legal,环境和社会考虑，以及医疗干预的成本和收益，以及相关方的不同观点。本文的目的是提出非核心域分析的实施，在卫生技术评估(HTA)机构/单位的报告中。为了评估有关MCDA技术的科学证据，我们使用各种HTA组织的生物医学数据库和网站中的结构化搜索进行了系统评价。使用名义小组技术并让医疗保健服务的用户参与，举行了一个共识小组，提供者,管理者和学者。补充,向HTA机构发送了一项调查，以确定MCDA在其方法中的实施程度。分析中包括42篇报告使用非核心标准评估卫生技术的文章。从这些文章中,研究人员共检索了216项非核心标准，并将其分类到多个领域中，其中，56个被归类为社会经济，59作为组织，10合法的，8是环境，47是道德，而36个被认为与其他领域有关。共识小组，根据从系统审查中获得的216个非核心标准，提议,并定义了26个标准，参与者认为这些标准对于医疗保健决策是必要的。共识小组不认为任何领域都应比其他领域更重要，也不认为任何单独的标准都应占主导地位。这些方法可以作为一个参考框架，以便就个别标准的基础和支持这些标准的证据进行结构良好的系统讨论。
