Murray Krahn1, Fiona Miller2, Ahmed Bayoumi3,4, Ann-Sylvia Brooker5, Frank Wagner6, Shawn Winsor7, Mita Giacomini8, Ron Goeree5, Holger Schünemann9, Gabrielle van der Velde2, Stephen Petersen10, Nancy Sikich10, Irfan Dhalla10. 1. Toronto General Hospital Research Institute, Toronto Health Economics and Technology Assessment Collaborative (THETA)murray.krahn@theta.utoronto.ca. 2. University of Toronto, Institute of Health Policy, Management and Evaluation. 3. University of Toronto Institute of Health Policy Management and Evaluation. 4. Li Ka Shing Knowledge Institute, Centre for Research on Inner City Health, The Keenan Research Centre. 5. No affiliation at present. 6. University of Toronto Joint Centre for Bioethics. 7. University of Toronto Dalla Lana School of Public Health. 8. McMaster University, Clinical Epidemiology & Biostatistics. 9. McMaster University, Departments of Clinical Epidemiology and Biostatistics and of Medicine. 10. Health Quality Ontario, Evidence Development and Standards.
Abstract
OBJECTIVES: In 2007, the Ontario Health Technology Advisory Committee (OHTAC) developed a decision framework to guide decision making around nondrug health technologies. In 2012, OHTAC commissioned a revision of this framework to enhance its usability and deepen its conceptual and theoretical foundations. METHODS: The committee overseeing this work used several methods: (a) a priori consensus on guiding principles, (b) a scoping review of decision attributes and processes used globally in health technology assessment (HTA), (c) presentations by methods experts and members of review committees, and (d) committee deliberations over a period of 3 years. RESULTS: The committee adopted a multi-criteria decision-making approach, but rejected the formal use of multi-criteria decision analysis. Three broad categories of attributes were identified: (I) context criteria attributes included factors such as stakeholders, adoption pressures from neighboring jurisdictions, and potential conflicts of interest; (II) primary appraisal criteria attributes included (i) benefits and harms, (ii) economics, and (iii) patient-centered care; (III) feasibility criteria attributes included budget impact and organizational feasibility. CONCLUSION: The revised Ontario Decision Framework is similar in some respects to frameworks used in HTA worldwide. Its distinctive characteristics are that: it is based on an explicit set of social values; HTA paradigms (evidence based medicine, economics, and bioethics/social science) are used to aggregate decision attributes; and that it is rooted in a theoretical framework of optimal decision making, rather than one related to broad social goals, such as health or welfare maximization.
OBJECTIVES: In 2007, the Ontario Health Technology Advisory Committee (OHTAC) developed a decision framework to guide decision making around nondrug health technologies. In 2012, OHTAC commissioned a revision of this framework to enhance its usability and deepen its conceptual and theoretical foundations. METHODS: The committee overseeing this work used several methods: (a) a priori consensus on guiding principles, (b) a scoping review of decision attributes and processes used globally in health technology assessment (HTA), (c) presentations by methods experts and members of review committees, and (d) committee deliberations over a period of 3 years. RESULTS: The committee adopted a multi-criteria decision-making approach, but rejected the formal use of multi-criteria decision analysis. Three broad categories of attributes were identified: (I) context criteria attributes included factors such as stakeholders, adoption pressures from neighboring jurisdictions, and potential conflicts of interest; (II) primary appraisal criteria attributes included (i) benefits and harms, (ii) economics, and (iii) patient-centered care; (III) feasibility criteria attributes included budget impact and organizational feasibility. CONCLUSION: The revised Ontario Decision Framework is similar in some respects to frameworks used in HTA worldwide. Its distinctive characteristics are that: it is based on an explicit set of social values; HTA paradigms (evidence based medicine, economics, and bioethics/social science) are used to aggregate decision attributes; and that it is rooted in a theoretical framework of optimal decision making, rather than one related to broad social goals, such as health or welfare maximization.
Entities:
Keywords:
Decision framework; Health technology; Health technology assessment; Multi-criteria decision making; Values
Authors: Robin Z Hayeems; Christian R Marshall; Meredith K Gillespie; Anna Szuto; Caitlin Chisholm; Dimitri J Stavropoulos; Viji Venkataramanan; Kate Tsiplova; Sarah Sawyer; E Magda Price; Lynette Lau; Reem Khan; Whiwon Lee; Lijia Huang; Olga Jarinova; Wendy J Ungar; Roberto Mendoza-Londono; Martin J Somerville; Kym M Boycott Journal: CMAJ Open Date: 2022-05-24