Article type
Abstract
Background: Qualitative multicriteria decision analysis (MCDA) methodologies are increasingly recognized as valuable aids in health coverage decision-making processes. In particular, evidence to decision frameworks (EtDFs) stand out for their application in coverage decisions, clinical practice guidelines, and evidence-informed policymaking. However, EtDFs lack the ability to prioritize among different health technologies. Moreover, prioritization in group settings poses complex issues such as strategic voting, Condorcet's paradox, and Arrow’s impossibility theorem. Majority judgment algorithm (MJA) has emerged as a promising method for prioritization based on aggregation of individual grades. Despite the potential of using EtDFs jointly with MJA, previous attempts to utilize them for the prioritization of health technologies have not been identified.
Objective: To assess the combined use of EtDFs with MJA for prioritizing health technologies within a universal high-cost medicines' coverage system
Methods: The study was conducted in the context of Chile's high-cost technologies coverage program. Before prioritization, the Ministry of Health (MoH) conducted a comprehensive health technology assessment (HTA), evaluating technologies regarding evidence of clinical effectiveness, budget impact, and implementation feasibility. Subsequently, a committee comprising 15 external experts evaluated the synthesized evidence and collectively judged each dimension of a modified EtDF for coverage. Each commissioner graded disease-intervention pairs on a scale ranging from “urgent need for inclusion” to “no need for inclusion,” with the MJA processing these grades to generate a prioritized list of technologies.
Results: The committee included representatives from academia, patient associations, and public institutions, presided over by the Vice Minister of Public Health. Through an interactive platform, the committee evaluated 60 treatment indications across 22 health conditions, reaching consensus judgments for each dimension of the EtDF. The application of the MJA produced a prioritized list. Financial availability provided the cutoff for coverage.
Discussion: The combined use of EtDFa and MJA provided a robust methodological framework for technology prioritization, addressing the need for collective decision-making while preserving individual input. The secrecy of individual votes in MJA minimized the influence of dominant members.
Conclusions: Integrating EtDF with MJA offers a pragmatic approach to health technology prioritization, overcoming some limitations associated with qualitative MCDA methods.
Objective: To assess the combined use of EtDFs with MJA for prioritizing health technologies within a universal high-cost medicines' coverage system
Methods: The study was conducted in the context of Chile's high-cost technologies coverage program. Before prioritization, the Ministry of Health (MoH) conducted a comprehensive health technology assessment (HTA), evaluating technologies regarding evidence of clinical effectiveness, budget impact, and implementation feasibility. Subsequently, a committee comprising 15 external experts evaluated the synthesized evidence and collectively judged each dimension of a modified EtDF for coverage. Each commissioner graded disease-intervention pairs on a scale ranging from “urgent need for inclusion” to “no need for inclusion,” with the MJA processing these grades to generate a prioritized list of technologies.
Results: The committee included representatives from academia, patient associations, and public institutions, presided over by the Vice Minister of Public Health. Through an interactive platform, the committee evaluated 60 treatment indications across 22 health conditions, reaching consensus judgments for each dimension of the EtDF. The application of the MJA produced a prioritized list. Financial availability provided the cutoff for coverage.
Discussion: The combined use of EtDFa and MJA provided a robust methodological framework for technology prioritization, addressing the need for collective decision-making while preserving individual input. The secrecy of individual votes in MJA minimized the influence of dominant members.
Conclusions: Integrating EtDF with MJA offers a pragmatic approach to health technology prioritization, overcoming some limitations associated with qualitative MCDA methods.