'Real-world' health care priority setting using explicit decision criteria: a systematic review of the literature.

Ian Cromwell,Craig Mitton,Stuart J Peacock

doi:10.1186/s12913-015-0814-3

Abstract

BackgroundHealth care decision making requires making resource allocation decisions among programs, services, and technologies that all compete for a finite resource pool. Methods of priority setting that use explicitly defined criteria can aid health care decision makers in arriving at funding decisions in a transparent and systematic way. The purpose of this paper is to review the published literature and examine the use of criteria-based methods in ‘real-world’ health care allocation decisions.MethodsA systematic review of the published literature was conducted to find examples of ‘real-world’ priority setting exercises that used explicit criteria to guide decision-making.ResultsWe found thirty-three examples in the peer-reviewed and grey literature, using a variety of methods and criteria. Program effectiveness, equity, affordability, cost-effectiveness, and the number of beneficiaries emerged as the most frequently-used decision criteria. The relative importance of criteria in the ‘real-world’ trials differed from the frequency in preference elicitation exercises. Neither the decision-making method used, nor the relative economic strength of the country in which the exercise took place, appeared to have a strong effect on the type of criteria chosen.ConclusionsHealth care decisions are made based on criteria related both to the health need of the population and the organizational context of the decision. Following issues related to effectiveness and affordability, ethical issues such as equity and accessibility are commonly identified as important criteria in health care resource allocation decisions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0814-3) contains supplementary material, which is available to authorized users.

Highlights

Health care decision making requires making resource allocation decisions among programs, services, and technologies that all compete for a finite resource pool
The purpose of this paper is to summarize the available literature on health care decision-making where explicit criteria-based methods like Programme Budgeting and Marginal Analysis (PBMA) or MultiCriteria Decision Analysis (MCDA) were used, in order to examine the criteria used by decision makers in ‘real world’, rather than hypothetical, settings
Some studies did not explicitly state the decision-making method, or used a synonymous term (e.g., “Decision Science”), and were classified as PBMA or MCDA based on the characteristics of the method used

Summary

Introduction

Health care decision making requires making resource allocation decisions among programs, services, and technologies that all compete for a finite resource pool. Methods of priority setting that use explicitly defined criteria can aid health care decision makers in arriving at funding decisions in a transparent and systematic way. The purpose of this paper is to review the published literature and examine the use of criteria-based methods in ‘real-world’ health care allocation decisions. Methods: A systematic review of the published literature was conducted to find examples of ‘real-world’ priority setting exercises that used explicit criteria to guide decision-making. Health care decision making requires the balancing of the demand for programs, services, and technologies that improve human health, and the need for fiscal restraint and the reality of a finite resource pool. Allocation decisions are influenced by a number of factors other than medical and health economic evidence – pragmatic issues of organizational structure and political realities are legitimate and important components of these decisions [2,3,4,5,6] and must be considered as well.

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