A systematic review of coverage decision-making on health technologies—Evidence from the real world

Fischer, Katharina Elisabeth

doi:10.1016/j.healthpol.2012.07.005

Cited by 47 publications

(38 citation statements)

References 66 publications

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“…One review of quantitative studies identified existing empirical evidence about coverage decisions for a range of health technologies [39]. Despite not being directly comparable with our study given it included all types of technologies, it is of interest to ensure that the components of HTA included in our study are comprehensive.…”

Section: How Do Our Findings Fit With Existing Evidence?mentioning

confidence: 99%

Developing an evidence-based methodological framework to systematically compare HTA coverage decisions: A mixed methods study

Nicod

Kanavos

2016

Health Policy

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Original citation:Nicod, Elena and Kanavos, Panos (2016) Developing an evidence-based methodological framework to systematically compare HTA coverage decisions: a mixed methods study. Health Policy, 120 (1). pp. 35-45. ISSN 0168-8510 DOI: 10.1016/j.healthpol.2015 Reuse of this item is permitted through licensing under the Creative Commons: a b s t r a c tHealth Technology Assessment (HTA) often results in different coverage recommendations across countries for a same medicine despite similar methodological approaches. This paper develops and pilots a methodological framework that systematically identifies the reasons for these differences using an exploratory sequential mixed methods research design. The study countries were England, Scotland, Sweden and France. The methodological framework was built around three stages of the HTA process: (a) evidence, (b) its interpretation, and (c) its influence on the final recommendation; and was applied to two orphan medicinal products. The criteria accounted for at each stage were qualitatively analyzed through thematic analysis. Piloting the framework for two medicines, eight trials, 43 clinical endpoints and seven economic models were coded 155 times. Eighteen different uncertainties about this evidence were coded 28 times, 56% of which pertained to evidence commonly appraised and 44% to evidence considered by only some agencies. The poor agreement in interpreting this evidence (Ä = 0.183) was partly explained by stakeholder input (n s = 48 times), or by agency-specific risk (n u = 28 uncertainties) and value preferences (n oc = 62 "other considerations"), derived through correspondence analysis. Accounting for variability at each stage of the process can be achieved by codifying its existence and quantifying its impact through the application of this framework. The transferability of this framework to other disease areas, medicines and countries is ensured by its iterative and flexible nature, and detailed description.

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Section: How Do Our Findings Fit With Existing Evidence?mentioning

confidence: 99%

Developing an evidence-based methodological framework to systematically compare HTA coverage decisions: A mixed methods study

Nicod

Kanavos

2016

Health Policy

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“…More people living longer with multiple comorbidities, and advancing medical technologies offering more treatment options, have led to greater complexity in clinical management and decision-making,[1–3] the more so if the person concerned lacks the capacity to participate in decisions about their care. As the end of life approaches, patients and clinicians may need to decide whether to continue life-sustaining treatments and artificial nutrition and hydration (ANH) which could also prolonging suffering.…”

Section: Introductionmentioning

confidence: 99%

Preferences for care towards the end of life when decision-making capacity may be impaired: A large scale cross-sectional survey of public attitudes in Great Britain and the United States

et al. 2017

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BackgroundThere is continuing public debate about treatment preferences at the end of life, and the acceptability and legal status of treatments that sustain or end life. However, most surveys use binary yes/no measures, and little is known about preferences in neurological disease when decision-making capacity is lost, as most studies focus on cancer. This study investigates changes in public preferences for care towards the end of life, with a focus on measures to sustain or end life.MethodsLarge-scale international public opinion surveys using a six-stage patient vignette, respondents chose a level of intervention for each stage as health and decision-making capacity deteriorated. Cross-sectional representative samples of the general public in Great Britain and the USA (N = 2016). Primary outcome measure: changes in respondents’ preferences for care, measured on a four-point scale designed before data collection. The scale ranged from: maintaining life at all costs; to intervention with agreement; to no intervention; to measures for ending life.ResultsThere were no significant differences between GB and USA. Preference for measures to sustain life at all costs peaked at short-term memory loss (30.2%, n = 610). Respondents selecting ‘measures to help me die peacefully’ increased from 3.9% to 37.0% as the condition deteriorated, with the largest increase occurring when decision-making capacity was lost (10.3% to 23.0%). Predictors of choosing ‘measures to help me die peacefully’ at any stage were: previous personal experience (OR = 1.34, p<0.010), and older age (OR = 1.09 per decade, p<0.010). Negative predictors: living with children (OR = 0.72, p<0.010) and being of “black” race/ethnicity (OR = 0.45, p<0.001).ConclusionsPublic opinion was uniform between GB and USA, but markedly heterogeneous. Despite contemporaneous capacitous consent providing an essential legal safeguard in most jurisdictions, there was a high prevalence of preference for “measures to end my life peacefully” when decision-making capacity was compromised, which increased as dementia progressed. In contrast, a significant number chose preservation of life at all costs, even in end stage dementia. It is challenging to respect the longstanding values of people with dementia concerning either the inviolability of life or personal autonomy, whilst protecting those without decision-making capacity.

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“…To this end, economic evaluation has been implemented in many areas, including coverage decisions, technology pricing and the development of clinical practice guidelines [2, 3]. Although economic evaluation is much more prevalent in high-income countries (HICs) [4], it may in principle make a bigger impact in low- and middle-income countries (LMICs) given the pressing needs in those settings [5, 6].…”

Section: Introductionmentioning

confidence: 99%

The influence of cost-per-DALY information in health prioritisation and desirable features for a registry: a survey of health policy experts in Vietnam, India and Bangladesh

Teerawattananon

Tantivess

Yamabhai

et al. 2016

Health Res Policy Sys

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BackgroundEconomic evaluation has been implemented to inform policy in many areas, including coverage decisions, technology pricing, and the development of clinical practice guidelines. However, there are barriers to evidence-based policy in low- and middle-income countries (LMICs) that include limited stakeholder awareness, resources and data availability, as well as the lack of capacity to conduct country-specific economic evaluations. This study aims to survey health policy experts’ opinions on barriers to use of cost-effectiveness data in these settings and to obtain their advice on how to make a new cost-per-DALY database being developed by Tufts Medical Center more relevant to LMICs. It also identifies the factors influencing transferability.MethodsIn-depth interviews were conducted with 32 participants, including policymakers, technical advisors, and researchers in Health Ministries, universities and non-governmental organisations in Bangladesh, India (New Delhi, Tamil Nadu and Karnataka) and Vietnam.ResultsThe survey revealed that, in all settings, the use of cost-effectiveness information in policy development is lacking, owing to limited knowledge among policymakers and inadequate human resources with health economics expertise in the government sector. Furthermore, researchers in universities do not have close connections with health authorities. In India and Vietnam, the demand for evidence to inform coverage decisions tends to increase as the countries are moving towards universal health coverage. The informants in all countries argue that cost-effectiveness data are useful for decision-makers; however, most of them do not perform data searches by themselves but rely on the information provided by the technical advisor counterparts. Most interviewees were familiar with using evidence from other countries and were also aware of the influences of contextual elements as a limitation of transferability. Finally, strategies to promote the newly developed database include training on basic economic evaluation for policymakers and researchers, and effective communication programs, with support from reputable global agencies.ConclusionsAlthough cost-effectiveness information is recognised as essential in resource allocation, there are several impediments in the generation and use of such evidence to inform priority setting in LMICs. As such, the Cost-per-DALY database should be well-designed and introduced with appropriate promotion strategies so that it will be helpful in real-world policymaking.Electronic supplementary materialThe online version of this article (doi:10.1186/s12961-016-0156-6) contains supplementary material, which is available to authorized users.

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A systematic review of coverage decision-making on health technologies—Evidence from the real world

Cited by 47 publications

References 66 publications

Developing an evidence-based methodological framework to systematically compare HTA coverage decisions: A mixed methods study

Developing an evidence-based methodological framework to systematically compare HTA coverage decisions: A mixed methods study

Preferences for care towards the end of life when decision-making capacity may be impaired: A large scale cross-sectional survey of public attitudes in Great Britain and the United States

The influence of cost-per-DALY information in health prioritisation and desirable features for a registry: a survey of health policy experts in Vietnam, India and Bangladesh

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