Value judgment of health interventions from different perspectives: arguments and criteria

Abstract

BackgroundThe healthcare sector is evolving while life expectancy is increasing. These trends put greater pressure on healthcare resources, prompt healthcare reforms, and demand transparent arguments and criteria to assess the overall value of health interventions. There is no consensus on the core criteria by which to value and prioritize interventions, and individual stakeholders might value specific elements differently. The present study is based on a literature review that retrieved the most widely recognized arguments and criteria used in decision-making. The aim was to compile a smaller set of arguments and criteria that would seem most relevant to different stakeholders.MethodsA literature review was performed in Medline and EMBASE. The initial search retrieved over 2000 articles and documents of relevant committees. A selection was made based on their reference to healthcare, policy issues, or social justice. Finally, 84 papers were included. Data extraction took place after appraisal of the articles. A full table was made, including all arguments and criteria found; next, identical or largely overlapping arguments were excluded. The remaining arguments and criteria were assessed for relevance and a reduced set was compiled.ResultsThe final set included 25 arguments and criteria, categorized by type (clinical, social justice, ethical, and policy). For each argument and criterion, relevance to stakeholders was scored on three levels (not, partly, and completely relevant).ConclusionsMany arguments and criteria play a role in making value judgments on health interventions, but not all are relevant to all interventions. Moreover, they may interact with each other. A viable way to deal with interacting and possibly conflicting arguments and criteria might be to arrange public discussions that would evoke different stakeholders’ perspectives.

Development of the WHO-INTEGRATE evidence-to-decision framework: an overview of systematic reviews of decision criteria for health decision-making

“…distribution of adverse events across all those affected by the intervention) or as an outcome (e.g. reduced health inequity several years Uptake of intervention [15,20,34,35] Magnitude of benefit/effect/impact [2,4,11,14,18,31,33,36] Additional or indirect effects [2,6,33,34] Type and composition of effect/ benefit/impact [2] Impact on mortality, survival, longevity and life expectancy [1, 2, 4, 11, 16, 19, 21, 24-26, 28, 34-36] Last chance therapies [23,24] Impact on morbidity and disability [1,2,16,35] Potential changes in health consequences [24,25] Impact on (health-related) quality of life [2,8,11,12,14,19,20,22,25,26,28,29,31,33,35,36] Impact on patient-reported outcomes [2,12,16,21,26]…”

“…Perceived priority of the problem Public perception of disease burden, disease risk or severity [15,34,35] Acceptability Acceptability in general [2,4,6,14,15,24,26,27,[34][35][36] Acceptability of cost and financial outcomes [2,14,25,26,34] Acceptability by beneficiaries Acceptability by beneficiaries: in general [2,6,8,11,15,16,26,35] Comfort, convenience and user experience [2, 11, 12, 14, 15, 20, 24-26, 31, 33, 35] Acceptability by those providing intervention Acceptability by those providing intervention [15,16,34,35] Social and cultural acceptability Social and cultural acceptability [2,4,8,9,11,15,18,21,22,25,26,[31][32][33][34]36] Ethical...…”

“…Advocacy and stakeholder (in general) interests and pressures [1,2,6,14,15,21,25,33,36] Demands, interest and pressures of the public [1,2,8,14,[24][25][26]36] Demands, interest and pressures by industry [2] Pressures, demand and interest of beneficiaries and patient representatives [2,17,20,22,25,32,33] Pressures, demand and interest of those providing intervention [2,17,20,25,26,32,33] Media attention and coverage [1,32] Societal considerations Societal needs and priority Social burden of disease (individual/population) [8,18,21,29,34,35] Social needs [24] Economic burden of disease on society (in general) [32] Social and societal impact Social impact or benefits [2, 3, 5, 6, 14, 21, 23-26, 31, 33, 35] Impact on non-health outcomes (in general) [15,18,26,…”

“…Impact on other spending/investments [2,6,14,25] Investment/start-up cost [2,22,30] Operating cost [2,30] Lifecycle cost of intervention/technology [30] Economic/financial benefits and cost-minimization potential [1,3,8,11,13,22,25,27,28,[34][35][36] Cost to/budget impact on government or society [1,2,5,18,25,26,29,33,36] Relation of cost and benefits Relation of cost and benefits [1-7, 9-16, 18-26, 28, 31-36] Financial context Appropriateness [2,14] Financial feasibility Affordability to health system Availability or lack of funds/funding [ Impact on management and organizational structure [2,8,11,25] Logistical considerations [2,15,34] Availability of, capacity of and need for monitoring, surveillance and information system [34,35] Resource considerations Availability of, capacity of and need for resources (in general) [ Donor and global interests and pressures…”

“…But in various areas of public health policy and practice, such structured processes are relied on in the evaluation or comparison of alternative interventions or modes of actions. This inter alia includes the allocation of resources [9], the setting of research priorities [8,17], decision-making about public health interventions [18], the assessment of health technologies for funding or reimbursement [19][20][21], or investment or disinvestment considerations [22]. Selecting the most appropriate and relevant criteria is a challenging but critical task in all of these structured decision-making processes.…”