Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis

Cost Effectiveness and Resource Allocation

Dan Wikler^1,10  Tessa Tan-Torres Edejer¹  Krishna D Rao^1,12  Thomas Mbeeli⁷  Peter Littlejohns^1,15  Lydia Kapiriri⁶  Kjell A Johansson²  Marc Fleurbaey⁸  Marion Danis⁹  Norman Daniels^1,10  Richard Cookson^1,11  Per Carlsson^1,13  DanW Brock⁵  Erik Nord^1,14  Dan Chisholm³  Mira Johri¹  Rob Baltussen⁴  Ole F Norheim² 

[1] Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Québec, Canada;Department of Global Public Health and Primary Care, University of Bergen, PB 7800, 5020 Bergen, Norway;Department of Health Systems Financing, World Health Organization, Geneva, Switzerland;Nijmegen International Centre for Health Systems Research and Education (NICHE), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;Harvard Medical School, Harvard University, Cambridge, USA;Department of Health, Aging, and Society, McMaster University, Hamilton, Canada;Ministry of Health and Social Services, Windhoek, Namibia;Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, USA;Section on Ethics and Health Policy, NIH Clinical Centre, Bethesda, USA;Harvard School of Public Health, Harvard University, Cambridge, USA;Centre for Health Economics, University of York, York, UK;Public Health Foundation of India, New Delhi, India;National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden;Norwegian Institute of Public Health, Oslo, Norway;Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King’s College London, Previous affiliation the National Institute for Health and Care Excellence (NICE), London, England, UK

关键词: Population health;    Equity;    Cost-effectiveness;    Resource allocation;    Priority setting;   

Others  :  1109988
DOI  :  10.1186/1478-7547-12-18

 received in 2014-04-05, accepted in 2014-07-18,  发布年份 2014

【 摘 要 】

This Guidance for Priority Setting in Health Care (GPS-Health), initiated by the World Health Organization, offers a comprehensive map of equity criteria that are relevant to health care priority setting and should be considered in addition to cost-effectiveness analysis. The guidance, in the form of a checklist, is especially targeted at decision makers who set priorities at national and sub-national levels, and those who interpret findings from cost-effectiveness analysis. It is also targeted at researchers conducting cost-effectiveness analysis to improve reporting of their results in the light of these other criteria.

The guidance was develop through a series of expert consultation meetings and involved three steps: i) methods and normative concepts were identified through a systematic review; ii) the review findings were critically assessed in the expert consultation meetings which resulted in a draft checklist of normative criteria; iii) the checklist was validated though an extensive hearing process with input from a range of relevant stakeholders.

The GPS-Health incorporates criteria related to the disease an intervention targets (severity of disease, capacity to benefit, and past health loss); characteristics of social groups an intervention targets (socioeconomic status, area of living, gender; race, ethnicity, religion and sexual orientation); and non-health consequences of an intervention (financial protection, economic productivity, and care for others).

【 授权许可】

   
2014 Norheim et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]World Health Report: Financing for Universal Coverage. Geneva: World Health Organization; 2010.
• [2]WHO: Making fair choices on the path to universal health coverage. Final report of the WHO Consultative Group on Equity and Universal Health Coverage. Geneva: World Health Organization; 2014. Available from: http://www.who.int/choice/documents/making_fair_choices/en/ webcite. [cited 2014 May 10]
• [3]Sassi F, Archard L, Le Grand J: Equity and the economic evaluation of healthcare. Health Technol Assess 2001, 5:3.
• [4]Weatherly H, Drummond M, Claxton K, Cookson R, Ferguson B, Godfrey C, Rice N, Sculpher M, Sowden A: Methods for assessing the cost-effectiveness of public health interventions: key challenges and recommendations. Health Policy 2009, 93(2–3):85-92.
• [5]Hauck K, Smith PC, Goddard M: The Economics of Priority Setting in Health Care. Washington, D.C., USA: The International Bank for Reconstruction and Development/ The World Bank; 2003.
• [6]Daniels N: Just Health: Meeting Health Needs Fairly. Cambridge: Cambridge University Press; 2008.
• [7]Brock D, Wikler D, et al.: Ethical Issues in Resource Allocation, Research, and New Products Development. In Disease Control Priorities in Developing Countries. 2nd edition. Edited by Jamison D, Breman J, Measham A. New York: Oxford University Press and the World Bank; 2006.
• [8]Nord E, Daniels N, Kamlet M: QALYs: Some Challenges. Value Health 2009, 12(Supplement 1):S10-S15.
• [9]Nord E: Towards cost-value analysis in health care? Health Care Anal 1999, 7(2):167-175.
• [10]Baltussen R, Stolk E, Chisholm D, Aikins M: Towards a multi-criteria approach for priority setting: an application to Ghana. Health Econ 2006, 15(7):689-696.
• [11]Brock DW, et al.: Ethical Issues in the Use of Cost Effectiveness Analysis for the Prioritization of Health Care Resources. In Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis. Edited by Tan-Torres Edejer T, Baltussen R, Adam T, Hutubessy R, Acharya A, Evans DB. Geneva: World Health Organization; 2003:289-312.
• [12]Tromp N, Baltussen R: Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers. BMC Health Serv Res 2012, 12:454. BioMed Central Full Text
• [13]Fleurbaey M, Schokkaert E: Equity in health and health care. In Handbook of Health Economics. Edited by Pauly M, McGuire T, Pita-Barros P. ᅟ: North-Holland; 2011.
• [14]Johri M, Norheim OF: Can cost-effectiveness analysis integrate concerns for equity? Systematic review. Int J Technol Assess Health Care 2012, 28(2):125-132.
• [15]WHO: CHOosing Interventions that are Cost Effective (WHO-CHOICE). 2012. [cited 2012 15 August]; Available from: http://www.who.int/choice/en/ webcite
• [16]DCP3: Disease control priorities project 3. ᅟ. [cited June 2013]; Available from: http://www.dcp-3.org/ webcite
• [17]Registry TC-E: ᅟ. 2014. [cited 2014 June 25]; Available from: https://research.tufts-nemc.org/cear4/Home.aspx webcite
• [18]Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL: Methods for the Economic Evaluation of Health Care Programmes. 3rd edition. New York: Oxford University Press; 2005.
• [19]Williams A: Intergenerational equity: an exploration of the ‘fair innings’ argument. Health Econ 1997, 6(2):117-132.
• [20]Culyer AJ, Wagstaff A: Equity and equality in health and health care. J Health Econ 1993, 12(4):431-457.
• [21]Wagstaff A, van Doorslaer E: Equity in Health Care Finance and Delivery. In Handbook of Health Economics, Volume 1. Edited by Culyer AJ, Newhouse JP. ᅟ: Elsevier; 2000.
• [22]Musgrove P: Public spending on health care: how are different criteria related? Health Policy 1999, 47(3):207-223.
• [23]Hontelez J, Lurie M, Bärnighausen T, Bakker R, Baltussen R, Tanser F, Hallett TB, Newell ML, de Vlas SJ: Elimination of HIV in South Africa through expanded access to antiretroviral therapy: a model comparison study. PLoS Med 2013, 10:10.
• [24]Baltussen R, Mikkelsen E, Tromp N, Hurtig A, Byskov J, Olsen Ø, Bærøe K, Hontelez JA, Singh J, Norheim OF: Balancing efficiency, equity and feasibility of HIV treatment in South Africa – development of programmatic guidance. Cost Eff Resour Alloc 2013, 11(1):26. BioMed Central Full Text
• [25]Dolan P, Shaw R, Tsuchiya A, Williams A: QALY maximisation and people’s preferences: a methodological review of the literature. Health Econ 2005, 14(2):197-208.
• [26]Nord E, Pinto JL, Richardson J, Menzel P, Ubel P: Incorporating societal concerns for fairness in numerical valuations of health programmes. Health Econ 1999, 8(1):25-39.
• [27]Daniels N: Four unsolved rationing problems. A challenge. Hastings Cent Rep 1994, 24(4):27-29.
• [28]Brock D: Priority to the Worse Off in health-Care Resource Prioritization. In Medicine and Social Justice. Edited by Rhodes R, Battin M, Silvers A. Oxford: Oxford University Press; 2002:362-372.
• [29]Ottersen T: Lifetime QALY prioritarianism in priority setting. J Med Ethics 2013, 39(3):175-180.
• [30]Norheim OF: Clinical priority setting. BMJ 2008, 337:a1846. doi:10.1136/bmj.a1846
• [31]National Institute of Health and Clinical Excellence: Infliximab (review) and adalimumab for the treatment of Crohn’s disease. May 2010. London: National Institute of Health and Clinical Excellence; 2010.
• [32]Nord E: Cost-Value Analysis in Health Care: Making Sense Out of QALYs. New York: Cambridge University Press; 1999.
• [33]Caro J, Nord E, Siebert U, McGuire A, McGregor M, Henry D, de Pouvourville G, Atella V, Kolominsky-Rabas P: The efficiency frontier approach to economic evaluation of health-care interventions. Health Econ 2010, 19(10):1117-1127.
• [34]Brock D: Ethical Issues in Recipient Selection for Organ Transplantation. In Organ Substitution Technology. Edited by Matthieu D. Boulder CO: Westview Press; 1988.
• [35]Norheim OF, Asada Y: The ideal of equal health revisited: definitions and measures of inequity in health should be better integrated with theories of distributive justice. Int J Equity Health 2009, 8:40. BioMed Central Full Text
• [36]Braveman P, Gruskin S: Defining equity in health. J Epidemiol Community Health 2003, 57(4):254-258.
• [37]Sen A: Why health equity? Health Econ 2002, 11:659-666. 2002;11:659–66
• [38]Marmot M, Allen J, Goldblatt P, Boyce T, McNeish D, Grady M, Geddes I: Fair Society, Healthy Lives: the Marmot Review. London: Ministry of Health UK; 2010.
• [39]Marmot M, Friel S, Bell R, Houweling TA, Taylor S: Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008, 372(9650):1661-1669.
• [40]Daniels N, Kennedy B, Kawachi I: Why justice is good for our health: the social determinants of health inequalities. Daedalus 1999, 128(4):215-251.
• [41]Lindholm L, Rosen M: On the measurement of the nation's equity adjusted health. Health Econ 1998, 7(7):621-8.
• [42]Daniels N: Fair process in patient selection for antiretroviral treatment in WHO’s goal of 3 by 5. Lancet 2005, 366(9480):169-171.
• [43]Baltussen R, Johri M, Norheim OF: Fairness in service choice: an important yet underdeveloped path to universal coverage. Trop Med Int Health 2010, 16(17):838-839.
• [44]Fleurbaey M, Luchini S, Muller C, Schokkaert E: Equivalent incomes and the economic evaluation of health care. Health Econ 2013, 22:711-729.
• [45]Murray C: Rethinking DALYs. In The Global Burden of Disease. Edited by Murray C, Lopez A. Cambridge Mass: Harvard School of Public Health, WHO, World Bank; 1996:1-98.
• [46]Murray CJ, Acharya AK: Understanding DALYs (disability-adjusted life years). J Health Econ 1997, 16(6):703-730.
• [47]Brock DW: Separate spheres and indirect benefits. Cost Eff Resour Alloc 2003, 1(1):4. BioMed Central Full Text
• [48]McPake B: User charges for health services in developing countries: a review of the economic literature. Soc Sci Med 1993, 36(11):1397-1405.
• [49]Hauck K, Smith P, Goddard M: The Economics of Priority Setting for Health: a Literature Review. Washington DC: The World Bank; 2002.
• [50]Smith P: Incorporating financial protection into decision rules for publicly financed healthcare treatments. Health Econ 2013, 22:180-193.
• [51]Smith P: User charges and priority setting in health care: balancing equity and efficiency. J Health Econ 2005, 24:1018-1029.
• [52]Teerawattananon Y, Mugford M, Tangcharoensathien V: Economic evaluation of palliative management versus peritoneal dialysis and hemodialysis for end-stage renal disease: evidence for coverage decisions in Thailand. Value in health 2007, 10(1):61-72.
• [53]Daniels N, Sabin JE: Setting Limits Fairly: Can We Learn to Share Medical Resources?. 2nd edition. Oxford: Oxford University Press; 2008.
• [54]Youngkong S, Kapiriri L, Baltussen R: Setting priorities for health interventions in developing countries: a review of empirical studies. Trop Med Int Health 2009, 14(8):930-939.
• [55]Youngkong S, Baltussen R, Tantivess S, Mohara A, Teerawattananon Y: Multicriteria decision analysis for including health interventions in the Universal Health coverage benefit package in Thailand. Value Health 2012, 15:961-970.
• [56]James C, Carrin G, Savedoff W, Hanvoravongchai P: Clarifying efficiency-equity tradeoffs through explicit criteria, with a focus on developing countries. Health Care Anal 2005, 13(1):33-51.
• [57]National Institute for Health and Clinical Excellence: Value Based Assessment of Health Technologies. London: NICE; 2014.
• [58]Verguet S, Laxminarayan R, Jamison DT: Universal Public Finance of Tuberculosis Treatment in India: An Extended Cost-Effectiveness Analysis. Disease Control Priorities in Developing Countries. Health Econ ᅟ, ᅟ:ᅟ. 2014 Feb 4. doi:10.1002/hec.3019
• [59]Littlejohns P, Weale A, Chalkidou K, Faden R, Teerawattananon Y: Social values and health policy: a new international research programme. J Health Organ Manag 2012, 26(3):285-292.
• [60]Tanios N, Wagner M, Tony M, Baltussen R, van Til J, Rindress D, Kind P, Goetghebeure M: Which criteria should be considered in health care decisions? Insights from an international survey of policy and clinical decisopn makers. Int J Techn Assessment 2013. 2013 (in press)
• [61]Golan O, Hansen P, Kaplan G, Tal O: Health technology prioritization: which criteria for prioritizing new technologies and what are their relative weights? Health Policy 2011, 102(2–3):126-135.
• [62]Persad G, Wertheimer A, Emanuel EJ: Principles for allocation of scarce medical interventions. Lancet 2009, 373(9661):423-431.
• [63]Kerstein SJ, Bognar G: Complete lives in the balance. Am J Bioeth 2010, 10(4):37-45.
• [64]Cappelen AW, Norheim OF: Responsibility in health care: a liberal egalitarian approach. J Med Ethics 2005, 31(8):476-480.
• [65]Daniels N: Democratic Equality: Rawls’s Complex Egalitarianism. In The Cambridge Companion to Rawls. Edited by Freeman S. Cambridge: Cambridge University Press; 2003:241-276.
• [66]Daniels N: Social and Individual Responsibility for Health. In Distributive Justice and Responsibility. Edited by Knight C, Stemplowska Z. Oxford and New York: Oxford University Press; 2011:266-287.
• [67]Wikler D: Personal and Social Responsibility for Health. In Public Health, Ethics, and Equity. Edited by Anand S, Peter F, Sen AK. Oxford: Oxford University Press; 2004:109-134.
• [68]Marchand S, Wikler D, Landesman B: Class, health and justice. Milbank Mem Fund Q 1998, 76(3):449-467.