Abstract
BackgroundApart from cost‐effectiveness, considerations like equity and acceptability may affect health‐care priority setting. Preferably, priority setting combines evidence evaluation with an appraisal procedure, to elicit and weigh these considerations.ObjectiveTo demonstrate a structured approach for eliciting and evaluating a broad range of assessment criteria, including key stakeholders’ values, aiming to support decision makers in priority setting.MethodsFor a set of cost‐effective substitute interventions for depression care, the appraisal criteria were adopted from the Australian Assessing Cost‐Effectiveness initiative. All substitute interventions were assessed in an appraisal, using focus group discussions and semi‐structured interviews conducted among key stakeholders.ResultsAppraisal of the substitute cost‐effective interventions yielded an overview of considerations and an overall recommendation for decision makers. Two out of the thirteen pairs were deemed acceptable and realistic, that is investment in therapist‐guided and Internet‐based cognitive behavioural therapy instead of cognitive behavioural therapy in mild depression, and investment in combination therapy rather than individual psychotherapy in severe depression. In the remaining substitution pairs, substantive issues affected acceptability. The key issues identified were as follows: workforce capacity, lack of stakeholder support and the need for change in clinicians’ attitude.ConclusionsSystematic identification of stakeholders’ considerations allows decision makers to prioritize among cost‐effective policy options. Moreover, this approach entails an explicit and transparent priority‐setting procedure and provides insights into the intended and unintended consequences of using a certain health technology.Patient contributionPatients were involved in the conduct of the study for instance, by sharing their values regarding considerations relevant for priority setting.
Highlights
Countries have limited public resources to invest in health care
In the UK, the National Institute for Health and Care Excellence (NICE) can consult a citizen council to elicit public perspectives on overarching moral and ethical issues that NICE should consider when providing guidance.[12]
The aim of this study was to demonstrate how the structured approach may add to the deliberative commission approach in that viewpoints on a range of pre-specified domains are elicited from diverse stakeholders, while leaving room for other domains
Summary
Countries have limited public resources to invest in health care. Technological innovations and resource constraints continuously challenge health-care priority setting.[1]. HTAs follow distinct phases: problem definition during a scoping phase, an evaluation according to different assessment criteria during an assessment phase and an appraisal of all available information by an independent multidisciplinary committee to provide policy recommendations during an appraisal phase.[7,8]. This organizational structure reflects growing recognition that the evaluation of evidence and public engagement techniques should be incorporated into priority-setting approaches.[9] HTA can be strengthened by a systematic approach to include robust evidence about patients’ perspectives and by ensuring effective engagement of patients in the entire HTA/appraisal process to create a fair deliberative process.[10] Several forms of public or patient engagement (e.g. telephone surveys, questionnaires or public meetings) can occur at various levels of the HTA process.[11] For example in the Netherlands, the assessment criteria are set and followed by stakeholder consultation rounds, where medical experts, patients, professional associations or other relevant health-care stakeholders may be consulted during the appraisal. The key issues identified were as follows: Health Expectations. 2021;00:1–11.
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