Med Decis Making - Bridging health technology assessment (HTA) and efficient health care decision making with multicriteria decision analysis (MCDA): applying the EVIDEM framework to medicines appraisal.

Tópicos

{ studi(2440) review(1878) systemat(933) }
{ ehr(2073) health(1662) electron(1139) }
{ research(1085) discuss(1038) issu(1018) }
{ group(2977) signific(1463) compar(1072) }
{ medic(1828) order(1363) alert(1069) }
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{ patient(2315) diseas(1263) diabet(1191) }
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{ signal(2180) analysi(812) frequenc(800) }
{ analysi(2126) use(1163) compon(1037) }
{ use(976) code(926) identifi(902) }
{ data(1737) use(1416) pattern(1282) }
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{ blood(1257) pressur(1144) flow(957) }
{ spatial(1525) area(1432) region(1030) }
{ health(3367) inform(1360) care(1135) }
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{ state(1844) use(1261) util(961) }
{ research(1218) medic(880) student(794) }
{ patient(2837) hospit(1953) medic(668) }
{ model(2656) set(1616) predict(1553) }
{ data(2317) use(1299) case(1017) }
{ age(1611) year(1155) adult(843) }
{ cost(1906) reduc(1198) effect(832) }
{ time(1939) patient(1703) rate(768) }
{ can(981) present(881) function(850) }
{ health(1844) social(1437) communiti(874) }
{ structur(1116) can(940) graph(676) }
{ high(1669) rate(1365) level(1280) }
{ cancer(2502) breast(956) screen(824) }
{ use(1733) differ(960) four(931) }
{ drug(1928) target(777) effect(648) }
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{ implement(1333) system(1263) develop(1122) }
{ process(1125) use(805) approach(778) }
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{ detect(2391) sensit(1101) algorithm(908) }

Resumo

CKGROUND: Health care decision making is complex and requires efficient and explicit processes to ensure transparency and consistency of factors considered.OBJECTIVES: To pilot an adaptable decision-making framework incorporating multicriteria decision analysis (MCDA) in health technology assessment (HTA) with a pan-Canadian group of policy and clinical decision makers and researchers appraising 10 medicines covering 6 therapeutic areas.METHODS: An appraisal group was convened and participants were asked to express their individual perspectives, independently of the medicines, by assigning weights to each criterion of the MCDA core model: disease severity, size of population, current practice and unmet needs, intervention outcomes (efficacy, safety, patient reported), type of health benefit, economics, and quality of evidence. Participants then assigned performance scores for each medicine using available evidence synthesized in a "by-criterion" HTA report covering each of the MCDA CORE model criteria. MCDA estimates of perceived value were calculated by combining normalized weights and scores. Feedback on the approach was collected through structured discussion.RESULTS: Relative weights on criteria varied widely, reflecting the diverse perspectives of participants. Scores for each criterion provided a performance measure, highlighting strengths and weaknesses of each medicine. MCDA estimates of perceived value ranged from 0.42 to 0.64 across medicines, providing comprehensive measures incorporating a large spectrum of criteria. Participants reported that the framework provided an efficient approach to systematic consideration in a pragmatic format of the multiple elements guiding decision, including criteria and values (MCDA core model) and evidence (HTA "by-criterion" report).CONCLUSIONS: This proof-of-concept study demonstrated the usefulness of incorporating MCDA in HTA to support transparent and systematic appraisal of health care interventions. Further research is needed to advance MCDA-based approaches to more effective healthcare decision making.

Resumo Limpo

ckground health care decis make complex requir effici explicit process ensur transpar consist factor consideredobject pilot adapt decisionmak framework incorpor multicriteria decis analysi mcda health technolog assess hta pancanadian group polici clinic decis maker research apprais medicin cover therapeut areasmethod apprais group conven particip ask express individu perspect independ medicin assign weight criterion mcda core model diseas sever size popul current practic unmet need intervent outcom efficaci safeti patient report type health benefit econom qualiti evid particip assign perform score medicin use avail evid synthes bycriterion hta report cover mcda core model criteria mcda estim perceiv valu calcul combin normal weight score feedback approach collect structur discussionresult relat weight criteria vari wide reflect divers perspect particip score criterion provid perform measur highlight strength weak medicin mcda estim perceiv valu rang across medicin provid comprehens measur incorpor larg spectrum criteria particip report framework provid effici approach systemat consider pragmat format multipl element guid decis includ criteria valu mcda core model evid hta bycriterion reportconclus proofofconcept studi demonstr use incorpor mcda hta support transpar systemat apprais health care intervent research need advanc mcdabas approach effect healthcar decis make

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