From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking

Cost Effectiveness and Resource Allocation

Review

Lalla Aïda Guindo¹  Donna Rindress¹  Monika Wagner¹  Mireille M Goetghebeur²  Rob Baltussen³  Janine van Til⁴  Paul Kind⁵ 

[1] BioMedCom Consultants, Montreal, Quebec, Canada;BioMedCom Consultants, Montreal, Quebec, Canada;Department of Health Administration, Faculty of medicine, University of Montreal, Montreal, Canada;Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;University of Twente, Enschede, The Netherlands;York University, Toronto, ON, Canada;

关键词: Decisionmaking;    Resource allocation;    Priority-setting;    Criteria;    Healthcare;   

DOI  :  10.1186/1478-7547-10-9

 received in 2012-01-20, accepted in 2012-06-28,  发布年份 2012

来源: Springer

【 摘 要 】

ObjectivesResource allocation is a challenging issue faced by health policy decisionmakers requiring careful consideration of many factors. Objectives of this study were to identify decision criteria and their frequency reported in the literature on healthcare decisionmaking.MethodAn extensive literature search was performed in Medline and EMBASE to identify articles reporting healthcare decision criteria. Studies conducted with decisionmakers (e.g., focus groups, surveys, interviews), conceptual and review articles and articles describing multicriteria tools were included. Criteria were extracted, organized using a classification system derived from the EVIDEM framework and applying multicriteria decision analysis (MCDA) principles, and the frequency of their occurrence was measured.ResultsOut of 3146 records identified, 2790 were excluded. Out of 356 articles assessed for eligibility, 40 studies included. Criteria were identified from studies performed in several regions of the world involving decisionmakers at micro, meso and macro levels of decision and from studies reporting on multicriteria tools. Large variations in terminology used to define criteria were observed and 360 different terms were identified. These were assigned to 58 criteria which were classified in 9 different categories including: health outcomes; types of benefit; disease impact; therapeutic context; economic impact; quality of evidence; implementation complexity; priority, fairness and ethics; and overall context. The most frequently mentioned criteria were: equity/fairness (32 times), efficacy/effectiveness (29), stakeholder interests and pressures (28), cost-effectiveness (23), strength of evidence (20), safety (19), mission and mandate of health system (19), organizational requirements and capacity (17), patient-reported outcomes (17) and need (16).ConclusionThis study highlights the importance of considering both normative and feasibility criteria for fair allocation of resources and optimized decisionmaking for coverage and use of healthcare interventions. This analysis provides a foundation to develop a questionnaire for an international survey of decisionmakers on criteria and their relative importance. The ultimate objective is to develop sound multicriteria approaches to enlighten healthcare decisionmaking and priority-setting.

【 授权许可】

Unknown   
© Guindo et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.