Development of the Ontario Decision Framework: A Values Based Framework for Health Technology Assessment

Abstract

Objectives: In 2007, the Ontario Health Technology Advisory Committee (OHTAC) developed a decision framework to guide decision making around nondrug health technologies. In 2012, OHTAC commissioned a revision of this framework to enhance its usability and deepen its conceptual and theoretical foundations. Methods: The committee overseeing this work used several methods: (a) a priori consensus on guiding principles, (b) a scoping review of decision attributes and processes used globally in health technology assessment (HTA), (c) presentations by methods experts and members of review committees, and (d) committee deliberations over a period of 3 years. Results: The committee adopted a multi-criteria decision-making approach, but rejected the formal use of multi-criteria decision analysis. Three broad categories of attributes were identified: (I) context criteria attributes included factors such as stakeholders, adoption pressures from neighboring jurisdictions, and potential conflicts of interest; (II) primary appraisal criteria attributes included (i) benefits and harms, (ii) economics, and (iii) patient-centered care; (III) feasibility criteria attributes included budget impact and organizational feasibility. Conclusion: The revised Ontario Decision Framework is similar in some respects to frameworks used in HTA worldwide. Its distinctive characteristics are that: it is based on an explicit set of social values; HTA paradigms (evidence based medicine, economics, and bioethics/social science) are used to aggregate decision attributes; and that it is rooted in a theoretical framework of optimal decision making, rather than one related to broad social goals, such as health or welfare maximization.

The ecosystem of health decision making: from fragmentation to synergy

“…Criteria that are related to HTAs and other disciplines include equity, feasibility, and acceptability, which include multiple facets as described in the guidance to the use of EtD frameworks by the GRADE working group and others. [21][22][23]55 Considerations about ethics (under values, equity, and acceptability) and legal aspects (under feasibility and acceptability) are included in these EtD frameworks. A difference between guidelines and HTAs is how the decision makers consider the precise balance and weight of the different criteria.…”

Picturing ELSI+: a visual representation of ethical, legal, and social issues, and patient experiences in Health Technology Assessment in Canada

“…Eleven social values relevant to HTA were identified by Giacomini: (1) Quality; (2) Evidence-informed policy; (3) Effectiveness; (4) Resource stewardship; (5) Resource sufficiency; (6) Equity; (7) Solidarity; (8) Population health; (9) Patient-centered care; (10) Collaboration; and (11) Shared responsibility for health (1). Many of these social values were distributed across our clusters.…”

“…Health technology assessment (HTA) is a form of policy research which synthesizes and appraises information, mainly from systematic reviews and cost-effectiveness analyses, to inform a policy question (1). Over recent decades, it has become apparent that decisions about health technologies (adoption, optimal use, disinvestment) are not only scientific questions, but are heavily value-laden.…”

Comparing genome sequencing technologies to improve rare disease diagnostics: a protocol for the evaluation of a pilot project, Genome-wide Sequencing Ontario

“…Three core dimensions on quality care will be ascertained: timeliness, diagnostic utility and cost-effectiveness. 23 Timeliness represents the core implementation outcome, and diagnostic utility and cost-effectiveness represent core effectiveness outcomes. In addition to patient-level clinical characteristics (i.e., enrolment site, age, physical features or symptoms, ethnicity, consanguinity, molecular testing history and test urgency) and patient preferences related to research recontact and receipt of secondary findings, patient-level details are collected to facilitate the assessment of implementation and effectiveness outcomes.…”