BRIDGING MULTICRITERIA DECISION ANALYSIS (MCDA) WITH HEALTH TECHNOLOGY ASSESSMENT (HTA) FOR POLICY AND CLINICAL DECISIONMAKING: CASE STUDIES IN CANADA AND SOUTH AFRICA

Purpose: To field-test a decision support framework (EVIDEM) and explore its utility for both clinical and health policy decisionmaking.

Method: Tramadol for chronic non-cancer pain (a) and liquid-based cytology for cervical cancer screening (b) were selected as relevant case studies for a public Canadian health plan and a private South African health plan policy making, respectively. For clinical decisionmaking, growth hormone for Turner syndrome was selected as a complex case study for pediatric endocrinologists (c). The framework included a MultiCriteria Decision Analysis (MCDA) matrix of 15 quantifiable decision criteria and a qualitative tool including six decision criteria. Web based health technology assessment (HTA) reports tailored to describe the evidence for each decision criterion was developed for the three interventions. Appraisal of these healthcare interventions using the framework was performed by health plan advisory committees (a+b) and by a panel of Canadian pediatric endocrinologists and other healthcare stakeholders (c). Feedback on the utility of the approach was collected.

Result: The HTA reports included synthesized data on disease severity, size of population affected, clinical guidelines, limitations of current interventions, improvement of efficacy, effectiveness, safety and patient reported outcomes, type of benefit provided as well as economic information. Relevance and validity of available data was assessed. The framework also incorporated ethical considerations (utility, efficiency and fairness), system capacity and risk of inappropriate use, potential stakeholder pressures and political and historical context. Each committee/panel member assigned weights and scores to each criterion of the MCDA matrix and explored the impact of non-quantifiable criteria on the appraisal of the intervention. Participants indicated that the framework helped ensure that systematic consideration was made of all relevant aspects of decision, and to increase consistency, transparency and clarity of decisions at both clinical and policy levels.

Conclusion: The framework stimulates reflection on values and priorities and allows consistent and transparent consideration of all relevant decision criteria as well as the underlying evidence. Further testing and validation is needed to develop the MCDA approach to healthcare decisionmaking.