integrate-hta how to integrate apples and oranges? – a systematic review of approaches to...
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INTEGRATE-HTAHow to integrate apples and oranges? –
A systematic review of approaches to integrate different dimensions in HTA
P. Wahlstera, R. Baltussenb, L. Breretonc, J. Burnsd, B. Hofmanne,
K. Mozygembaa, W. Oortwijnf, S. Polusd, E. Rehfuessd, G.J. van der Wiltb, A.
Gerhardus a
a Department for Health Services Research, University of Bremen, Bremen, Germany
b Department of Primary and Community Care, Radboud university medical center, The Netherlands
c School of Health and Related Research (ScHARR) Section of Public Health, Sheffield, United Kingdom
d Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Germany
e University of Oslo, Centre of Methical Ethics at the Institute for Health and Society at the Faculty of Medicine, Norway
f ECORYS, Health Unit, Rotterdam, The NetherlandsThis project is co-funded by the European Union under the Seventh Framework Programme (Grant Agreement No.
306141)
Definition of HTA
HTA is a “…multidisciplinary process that summarises information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner…”
(EUnetHTA n.d.)
What are the apples in HTA? What are the oranges?
Apples and oranges in HTA of palliative care•The variety of assessed aspects
• Example : Hospitalization, „good death“, continuity of care
•The assessment results
• Example: Effectiveness: effect size for several outcome parameters like mortality, morbidity, quality of life etc. Ethics: several identified issues like the importance of patient autonomy in palliative care
•Context as modifying factor and factor of uncertainty
• Example: socio-cultural factors like religion
•Values, preferences and understanding of all relevant stakeholders, including decision-makers
INTEGRATE-HTA
http://commons.wikimedia.org/wiki/File:Apple_and_Orange_-_they_do_not_compare.jpg?uselang=de
One decision
Aim of this study
INTEGRATE-HTA
This study aims to present a comprehensive overview of approaches to cover different aspects of integration in HTA.
Methods
INTEGRATE-HTA
Information sources and searchWeb of Science; Medline, PsycINFO and the non-medical databases Econlit, ASSIA, International Bibliography of the Social Sciences, Sociological abstracts were searched from January 2004 up to April 2014. Inclusion criteria • Methods including multiple, quantitative or qualitative aspects • Should include connective elements to merge criteria/ aggregate criteria/ address interdependencies between criteria • Address aspects of the data extraction framework about integrationExclusion criteria• Simply side-by-side assessment, frameworks that only provide decision criteria
Results of search strategy
INTEGRATE-HTA
30 approaches included in the synthesis.
2054 records assigned to the approach that was applied
Records excluded (Different topic e.g. basic research)
3848 Records identified after dublicates removed.
INTEGRATE-HTA
Data extraction
30 approaches:
MCDA approaches
Analytic approaches
Preference elicitation approaches
Consensus methods
Do
they
add
ress
…
Evidence issues e.g. effect sizes, context,
uncertainty
Judgment and evaluation issues e.g.
values and preferences
Decision issues e.g. comparissons to other
technologies
INTEGRATE-HTA
Extracted techniques of Integration
a. The separation of a decision into criteria
b. Structuring criteria
c. Performance matrix
d. Qualitative modelling techniques
e. Process based integration
f. Scoring and calculation techniques to integrate criteria
g. Techniques as input for deliberative discussions
h. Techniques for a structured deliberative discussion
i. Integrating uncertainty by addressing preferences and using criteria
j. Quantitative modelling techniques to address uncertainty of evidence
Apples and oranges in palliative care•Integration of assessed aspects • a. The separation of a decision into criteria • b. Structuring criteria
•The assessment results • c. Performance matrix
•Context as modifying factor • d. Qualitative modelling techniques
•Uncertainty• i. Integrating uncertainty by preferences and criteria• j. Quantitative modelling techniques to address uncertainty of
evidence
•Values, preferences and understanding of all relevant stakeholders, including decision-makers
• e. Process based integration • f. Scoring and calculation techniques to integrate criteria • h. Techniques for a structured deliberative discussion
INTEGRATE-HTA
http://commons.wikimedia.org/wiki/File:Apple_and_Orange_-_they_do_not_compare.jpg?uselang=de
One decision
Conclusion
INTEGRATE-HTA
• The results of this review provide guidance on suitable combinations of different methods.
• All identified techniques can be used in an additive manner as they all cover different aspects of integration.
This project is co-funded by the European Union under the Seventh Framework
Programme (Grant Agreement No. 306141)
www.integrate-hta.eu
INTEGRATE-HTA
This project is co-funded by the European Union under the Seventh Framework
Programme (Grant Agreement No. 306141)
Please join us at the final conference of the INTEGRATE-HTA-Project
at 12/13 November in Amsterdam
www.integrate-hta.eu
INTEGRATE-HTA
http://www.iamsterdam.com