Priority Setting Methods Research Articles

Resource Allocation in Orthopaedics

In 2000 the World Health Organization launched the "Bone and Joint Decade" campaign in part to promote cost-effective treatments. This will impact the organization, delivery, and funding of health care as the population ages. However, it is well recognized that resources in health care are limited and it is essential the resources available are used to best effect. Thus, there has been greater emphasis in the orthopaedic literature on the use of economics. Still, there is little discussion of whether and how the results of these economic methods can be further used to aid resource allocation decisions. We discuss the suitability of economic methods for priority setting in orthopaedic surgery, arguing economic evaluation alone is not sufficient for addressing resource allocation decisions. We also describe an alternative approach to priority setting that has been steadily gaining prominence within health economics--program budgeting and marginal analysis--and use a working example from the United Kingdom National Health Service to illustrate its application within orthopaedic surgery.

NIKE: a new clinical tool for establishing levels of indications for cataract surgery

The purpose of this study was to construct a new clinical tool for establishing levels of indications for cataract surgery, and to validate this tool. Teams from nine eye clinics reached an agreement about the need to develop a clinical tool for setting levels of indications for cataract surgery and about the items that should be included in the tool. The tool was to be called 'NIKE' (Nationell Indikationsmodell för Kataraktextraktion). The Canadian Cataract Priority Criteria Tool served as a model for the NIKE tool, which was modified for Swedish conditions. Items included in the tool were visual acuity of both eyes, patients' perceived difficulties in day-to-day life, cataract symptoms, the ability to live independently, and medical/ophthalmic reasons for surgery. The tool was validated and tested in 343 cataract surgery patients. Validity, stability and reliability were tested and the outcome of surgery was studied in relation to the indication setting. Four indication groups (IGs) were suggested. The group with the greatest indications for surgery was named group 1 and that with the lowest, group 4. Validity was proved to be good. Surgery had the greatest impact on the group with the highest indications for surgery. Test-retest reliability test and interexaminer tests of indication settings showed statistically significant intraclass correlations (intraclass correlation coefficients [ICCs] 0.526 and 0.923, respectively). A new clinical tool for indication setting in cataract surgery is presented. This tool, the NIKE, takes into account both visual acuity and the patient's perceived problems in day-to-day life because of cataract. The tool seems to be stable and reliable and neutral towards different examiners.

Evaluation of diagnostic imaging technologies and therapeutics devices: Better information for better decisions: Proceedings of a multidisciplinary workshop

We are entering an era in which the success of biomedical science and the increasing understanding of the value of evidence for practice are in a state of tension. This tension is especially notable in the device arena, in which the short life cycles and iterative nature of development are at odds with current design constructs of the types of clinical trials that provide evidence for medical decision making. The financial pressure arising from strained budgets and expanding costs from the aging of the population and the continued development of new technology heightens the need for a focus on new approaches. Given this background, a group of experts representing constituencies with different perspectives were convened for a day and a half to discuss key issues and their potential solutions. Because of the complex and heterogeneous nature of the environments in which devices are used, the meeting focused on 3 broad, general uses of devices: imaging, risk stratification, and therapeutics. The goal of the meeting was to develop a preliminary list of ideas that could be framed as researchable questions or constructs for consideration by policy makers that ultimately might lead to improvements in the current system. Across diagnostic imaging, risk stratification devices, and therapeutic devices, the crosscutting issues can be identified: We need better methods of collaborative funding and priority setting, improved and more flexible methods, and new approaches to the integration of federal agencies in overseeing the system.

Current costing models: are they suitable for allocating health resources?The example of fall injury prevention in Australia

The example of fall injury among older people is used to define and illustrate how current Australian systems for allocation of health resources perform for funding emerging public health issues. While the examples are Australian, the allocation and priority setting methods are common in the health sector in all developed western nations. With an ageing population the number of falls injuries in Australia and the cost of treatment will rise dramatically over the next 20–50 years. Current methods of allocating funds within the health system are not well suited to meeting this coming epidemic. The information requirements for cost-benefit and cost-effectiveness measures cannot be met. Marginal approaches to health funding are likely to continue to fund already well-funded treatment or politically driven prevention processes and to miss the opportunity for new prevention initiatives in areas that do not have a high political profile. Fall injury is one of many emerging areas that struggle to make claims for funding because the critical mass of intervention and evidence of its impact is not available. The beneficiaries of allocation failure may be those who treat the disease burden that could have been easily prevented. Changes to allocation mechanisms, data systems and new initiative funding practices are required to ensure that preventative strategies are able to compete on an equal footing with treatment approaches for mainstream health funding.

Search area Expanding Strategy and Dynamic Priority Setting Method in the Improved 2-opt Method

We propose a new 2-opt base method in a Memetic algorithm, that is, Genetic Algorithms(GAs) with a local search. The basic idea is from the fast 2-opt(1) method and the improved 2-opt method(20). Our new search method uses the “Priority" employed in the improved 2-opt method. The “Priority" represents the contribution level in exchange of genes. Matayoshi's method exchanges genes based on previous contribution to the fitness value improvement. We propose a new search method by using the concept of the Priority. We call our method the search area expanding strategy method in the improved 2-opt method. Our method escalates the search area by using “Priority". In computer experiment, it is shown that the computation time to find exact solution depends on the value of the Priority. If our method does not set an appropriate priority beforehand, then we propose the method to adapt to suitable value. If improvement does not achieved for certain generations, our dynamic priority method tries to modify the priority by the mutation operation.Experimental results show that the search area expanding strategy method embedded with the dynamic priority setting method can find the exact solution at earlier generation than other methods for comparison.

A method for cross-sector priority setting. Gaps and hypotheses in malaria research: Tanzania.

This study proposes a new priority setting method for identifying critical information gaps in a multisector system. The method uses graph-theoretical concepts and principles of systems theory in characterizing the underlying information structure of the system. Its application is illustrated in the context of malaria control in Tanzania, drawing on the findings of a workshop held in October 2003 in Dar es Salaam. The workshop identified two critical pathways, EVHA and EVHPA, which warrant better understanding. The first suggests that the malaria research should generate information on the effects of environmental changes (E) on vector ecology (V) and then on the effects of V on human health (H) and then on the effects of H on agriculture (A). Interpreted likewise, the second pathway additionally points to the need for information on the effects of socioeconomic conditions (P) on A.

Current costing models: are they suitable for allocating health resources?: The example of fall injury prevention in Australia

The example of fall injury among older people is used to define and illustrate how current Australian systems for allocation of health resources perform for funding emerging public health issues. While the examples are Australian, the allocation and priority setting methods are common in the health sector in all developed western nations. With an ageing population the number of falls injuries in Australia and the cost of treatment will rise dramatically over the next 20–50 years. Current methods of allocating funds within the health system are not well suited to meeting this coming epidemic. The information requirements for cost-benefit and cost-effectiveness measures cannot be met. Marginal approaches to health funding are likely to continue to fund already well-funded treatment or politically driven prevention processes and to miss the opportunity for new prevention initiatives in areas that do not have a high political profile. Fall injury is one of many emerging areas that struggle to make claims for funding because the critical mass of intervention and evidence of its impact is not available. The beneficiaries of allocation failure may be those who treat the disease burden that could have been easily prevented. Changes to allocation mechanisms, data systems and new initiative funding practices are required to ensure that preventative strategies are able to compete on an equal footing with treatment approaches for mainstream health funding.

A Cross-Sector Priority Setting Method: Critical Gaps in Malaria Research in Tanzania

This Briefing Paper proposes a new priority setting method for identifying critical information gaps in a multi-sector system. This method uses graph-theoretical concepts in characterizing the information structure of this system. Its application is illustrated in the context of malaria research in Tanzania. Two critical pathways, EVHA and EVHPA, were identified that warrant better understanding. The first suggests that the malaria research should generate information on the effects of environmental changes (E) on vector ecology (V) and then on the effects of V on human health (H) and then on the effects of H on agriculture (A). Interpreted likewise, the second pathway additionally points to the need for information on the effects of socio-economic conditions (P) on A.

The Politics of Priority Setting for Reproductive Health: Breast and Cervical Cancer in Ghana

Priority setting for reproductive health is affected by health sector reform policies, the often politically charged nature of issues such as abortion, decreasing funding for reproductive health activities and the broad agenda of the ICPD Programme of Action. This paper examines the influence of political and organizational factors on national priority setting for reproductive health and argues that existing priority setting tools such as disability-adjusted life years and cost-effectiveness analysis do not consider the influence of politics on the priority setting process or account for the interpretation of evidence in priority setting. It suggests that priority setting tools can be strengthened by incorporating empirical measures of political and organizational attention to an issue, and through a new measure – policy priority. The paper applies this new measure to a case study of attention to breast and cervical cancer in Ghana from 1990–97, illustrating how traditional priority setting methods cannot explain the priority given to breast cancer in Ghana. It demonstrates how local politics can trump scientific and economic evidence and suggests that the priority setting process can have unforeseen equity and social implications. It concludes by arguing that the policy priority measure provides a more complete picture of reproductive health priorities and is useful for better understanding the implications of the priority setting process for reproductive health.

A method for research programming in the field of evidence-based medicine.

This paper presents the method we used in programming research on the efficacy of therapeutic interventions for nine chronic benign pain disorders. We started with an inventory to identify commonly applied interventions. For these interventions we searched the literature to identify gaps in evidence. First, we searched for recent reviews, of which we assessed the methodologic quality. If only reviews of poor or moderate quality were found, a new systematic review was recommended. When we found no recent reviews, we searched for randomized controlled trials (RCTs). If there was insufficient or inconsistent evidence, the performance of a new RCT was advised. This structured procedure resulted in a list with topics for which new systematic reviews were recommended and topics for which new RCTs were needed. These lists were the starting points for priority setting by four Centers for Pain Management and Research. All members of the centers were asked to state the priority of each topic. The resulting hierarchy of topics for their own center was discussed in a meeting in each center, giving participants the opportunity to elucidate their views and considerations. The final result was a robust priority list for the need of research (systematic reviews and RCTs) on chronic benign pain syndromes. The strength and weaknesses of this approach are discussed. This method of priority setting is by no means restricted to treatments for chronic pain; it is also a useful approach for programming research to enable evidence-based medicine in other fields of interest.

Methods for priority setting among clinical preventive services

Overview: Methods used to compare the value of clinical preventive services based on two criteria—clinically preventable burden (CPB) and cost effectiveness (CE)—are described. A companion article provides rankings of clinical preventive services and discusses its uses for decision-makers; this article focuses on the methods, challenges faced, and solutions. The authors considered all types of data essential to measuring CPB and CE for services recommended by the U.S. Preventive Services Task Force and developed methods essential to ensuring valid comparisons of different services’ relative value.

Priority setting for existing chemicals: Automated data selection routine

One of the four steps within Council Regulation 793/93/EEC on the evaluation and control of existing chemicals is the priority setting step. The priority setting step is concerned with selecting high-priority substances from a large number of substances, initially starting with 2,474 high-production-volume chemicals. In order to be able to efficiently carry out the priority setting step, an automated priority setting method was developed, the so-called European Union risk ranking method (EURAM). The EURAM produces rankings among the high-production-volume chemicals appearing in the International Uniform Chemical Information Database (IUCLID). As part of a publication series, this paper deals with the data selection criteria used in EURAM and furthermore with data validation of the selected data. To validate the selected data in EURAM, comparisons are made with validated data of priority chemicals for which European Union risk assessment reports have been completed or with data of priority chemicals from the Screening Information Data Set initial assessment reports of the Organization for Economic Cooperation and Development. Regression analysis between the selected data in EURAM and the data selected by expert judgment in the assessment procedure resulted in good correlation for physicochemical properties and aquatic toxicity data. In addition, the type of biodegradation (i.e., readily biodegradable, inherently biodegradable, or nonbiodegradable) selected by EURAM also was in agreement with the type of biodegradation selected by expert judgment in the risk assessment procedure. Hence, the good correlation between the automated data selection procedure of EURAM and the data selection by expert judgment indicates that the data selection criteria of EURAM, which are developed in order to select data for priority purposes among high-production-volume chemicals in IUCLID, seem to perform well. Chemicals/CAS: 1,3 butadiene, 106-99-0, 25339-57-5; 4,4' methylenedianiline, 101-77-9; acetone, 67-64-1; acrolein, 107-02-8; acrylamide, 79-06-1; acrylic acid, 10344-93-1, 79-10-7; acrylonitrile, 107-13-1; chlorobenzene, 108-90-7; cumene, 98-82-8; diethanolamine, 111-42-2; maleic acid diethyl ester, 141-05-9; methacrylic acid methyl ester, 80-62-6; methacrylic acid, 18358-13-9, 79-41-4; phenetidine, 1321-31-9; phthalic acid dibutyl ester, 84-74-2; propylene oxide, 75-56-9; styrene, 100-42-5; trichloroacetic acid, 14357-05-2, 76-03-9; trichloroethylene, 79-01-6; xylene, 1330-20-7

Targeting poverty alleviation in priority setting for agricultural research

This paper provides a brief overview of research priority setting methods at various levels in national research systems, noting the changing emphasis from supply- to demand-driven approaches at both macro- and micro-levels of priority setting. The scope for incorporating a poverty dimension into priority setting is then reviewed within a general framework that recognises the complexity of the link between research investments and poverty alleviation. The effectiveness of this targeting is likely to be very situation specific. A case study of macro priority setting in Pakistan shows the limited scope to target benefits to the poor through re-allocation of research resources among commodities, relative to a ranking based on the efficiency objective. Given present knowledge, enhancing the efficiency and effectiveness of research systems in promoting broad-based technical change should be emphasised more than major efforts to target poverty directly. This will involve a combination of supply- and demand-driven approaches to priority setting at different levels in the research system that will enhance both the efficiency and poverty alleviation impacts of research.

The social and economic importance of livestock and their influence on setting research agendas

AbstractLivestock make a significant contribution to the world's supply of protein and energy. They occupy dry and cold areas where crop farming is not possible, as well as integrating with crops in warmer, wetter zones. In developing countries they play a major part in household dynamics and family social status. This implies that they should be given serious consideration when agricultural research agendas are set and resources allocated. This paper examines some of the processes used for research priority setting and comments on the likely impact of these processes in setting research agendas for livestock. One case study is considered in detail, that of the Kenya Agricultural Research Institute (KARI).Methods for prioritization of research range from the very informal, where priorities are determined by discussion in small expert groups, to the comparatively formal and quantitative estimation of economic surpluses. Between those extremes are a variety of methodologies for selecting and ranking research programmes and projects. In a liberalized economy, market forces will play a large part in determining the research agenda; in a centrally planned economy, the national research agenda will be determined by the government, although the trend is towards focusing on the needs of the end user. No one method can guarantee results, since effective research prioritization depends on accurate prediction of future demand. All methods have a degree of subjectivity and may be biased by the selection of stakeholders involved in the debate.This paper proposes that more rigorous methodology will tend to make results more objective, more transparent and by introducing an explicit market orientation will facilitate the transition from central planning to competitive bidding, but users of any method should be aware of its limitations. The economic surplus method, possibly the most rigorous currently available for setting a national research agenda, is limited by thefact that it does not require measures of social or environmental impact, and to include these requires an additional weighting process. Any trend towards methodological rigour, whether quantitative or qualitative, has costs in terms of data gathering, time and the necessary training to carry out the analyses.KARI has over the last 10 years moved through the full spectrum of priority-setting methods from informal to formal. It is at present engaged in setting priorities for the next 5-year span, using an economic surplus approach. Some of its experiences and lessons are described in this paper, with particular reference to livestock programmes. The authors conclude that a systematic process of setting research agendas will, on the whole, be favourable to livestock. There has in some cases been a tendency to exclude them because they are harder to work with than annual crops, research can be more costly, their value is harder to estimate and benefits take longer to accrue. A rigorous process of’ estimating benefits from research, with a reasonably long time horizon, should provide a realistic assessment of the value of livestock to an economy and is likely to encourage investment in livestock research.

A comparative study of priority setting methods for planned maintenance of public buildings

There is an increasing demand for research in maintenance prioritization methods, as budgets for maintenance of public buildings are unlikely to meet the maintenance needs. It is possible for government maintenance authorities to improve this situation by ensuring that the best solution is achieved in the maintenance programme through appropriate priority setting methods. A maintenance plan that is based on a rational assessment of priorities and up‐to‐date knowledge of the condition of the property stock will help to ensure the best use of available resources. Critically reviews various methods of maintenance priority setting for public buildings in the UK and Hong Kong. It also provides recommendations for maintenance managers in selecting and using the most appropriate method for their own organizations.

Sustainable Forest Management in Tropical Rain Forests

In planning of sustainable forest management, economic, environmental and social demands often conflict. Forest management in Southeast Asian tropical dipterocarp forests has been particularly biased towards maximizing immediate economic return from extensive logging. Overexploitation and other forms of uncontrolled land use within these forests have led to the situation where the remaining natural forests, most of them in Indonesia, will be liquidated within the next 10-15 years at the current rate of deforestation. In this paper we present an approach for sustainable forest management planning in which economic, environmental and social sustainability are considered simultaneously in order to define an optimal management strategy from a set of available alternatives. We carried out a case study within a rain forest logging concession in Indonesian Borneo by using a participatory planning approach involving interviews of the local people, environmental assessment and economic analyses. We used the Analytic Hierarchy Process (AHP) method for resource allocation and priority setting in order to identify an optimal strategy which yields a sustained economic output from timber production, while at the same time being environmentally and socioculturally sustainable. Despite their relatively high costs, strategies involving selective harvesting combined to complete restoration of original dipterocarp stock in logged-over areas were superior in terms of economic, environmental and social sustainability. Priorities set by local communities for the strategies to meet their socioeconomic and cultural needs coincide well with those ensuring the restoration and biodiversity.

Processes and methods for research programme priority setting: the experience of the Kenya Agricultural Research Institute Wheat Programme

As funding for agricultural research in developing countries becomes increasingly scarce, national research institutes must develop efficient processes for targeting available resources to meet client needs. This paper presents the application of a rigorous process for setting national commodity programme research priorities both spatially and by major research theme. The exercise is conducted in three phases with the Kenya Agricultural Research Institute Wheat Programme. First, a working group of Wheat Programme scientists develops a consensus on programme target zones as well as the potential for the generation and adoption of technologies in those zones. Secondly, the working group assumptions are combined with available economic data to develop ex ante economic surplus measures of programme impact. Thirdly, the results are presented to a larger group of programme stakeholders in order to review the working group assumptions, establish research priorities and then translate those priorities into guidelines for research managers on resource allocation decisions.

Needs and methods for priority setting for estimating the intake of food additives.

Direct measurement of the intake of food additives is a complex, time-consuming and expensive process. Prioritization of intake surveys is important to focus initial attention on those additives of most concern. Intakes at or below the Acceptable Daily Intake (ADI) are not of concern, by definition, and therefore a high priority should be given to those additives for which simple, but conservative, theoretical estimates of potential intake indicate a probability of exceeding the ADI. Although ADI values for different additives are equivalent, because they are based on No-Observed-Adverse-Effect Levels (NOAELs), the risk associated with intakes above the ADI can only be determined by reference back to the data which are the basis for the ADI estimation. In consequence the nature and severity of toxic effects detected in animal experiments above the NOAEL should be taken into account in the prioritization of intake surveys. A scheme is proposed which incorporates both exposure estimation and toxicology in determining which food additives should be allocated a high priority for inclusion in intake surveys.

Subcommittee examines NSF's role

On March 3, the House Subcommittee on Science continued its examination of scientific research with the second in a series of hearings on renewing U.S. science policy. The hearing focused on the report by the National Science Board's Commission on the Future of the National Science Foundation, released last November. The subcommittee chairman, Rick Boucher (D‐Va.), in cooperation with full science committee chairman George Brown (D‐Calif.), plans further hearings throughout the year to look at the way science is funded, how it contributes to national needs, and whether a better method of priority setting is necessary.The NSB Commission, according to witness James Duderstadt, NSB chairman, “strongly reaffirms [NSF's support of] curiosity‐driven, peer‐reviewed science.” The witnesses unanimously concurred with the commission's finding that, in general, NSF's traditional mission is appropriate and the foundation is performing it well. They recommended no major changes to the agency's mission.

Agricultural Research Institutions and Priorities in an Era of Resource Scarcity: Discussion

The architects of this session have highlighted an important theme in a timely manner, although I have yet to discover when there was an era in which resources were not scarce. Part of the timeliness relates to the links between these papers and the imminent production of three important monographs: one on methods of priority setting that I will refer to here as (Norton, Pardey, and Alston); the second reports a major exercise being undertaken by TAC/CGIAR that I will refer to as (McCalla and Ryan); and the third an in-depth analysis of the U.S. agricultural research system (Huffman and Evenson) that I will refer to as (Just and Huffman). Constraints of time and space being what they are, the authors have done well to do as much justice as they have to the scope of their respective fuller works in these presentations. Analogous constraints apply to the discussants and, accordingly, I will focus on just a few key features of these welcome and commendable contributions. Most of my remarks are addressed to the first two papers, for the good reason that they arrived in time to be read before these comments were due, but Direction (and the related book) is clearly an extremely useful contribution because of the size, stature, and global significance of the U.S. system (especially as a much-albeit imperfectly-mimicked role model), and because of the course it seems to be headed. In the preliminary version of Direction that I had the chance to skim, I particularly appreciated the analysis of why the advantages of the (oft-vaunted) competitive grants in publicly funded research are so exaggerated. One common issue in the two papers, which are so centrally addressed to tradeoffs, is yet another (I think rather under-mentioned) tradeoff between transparency and comprehensive realism. The latter attribute in turn determines credibility, and just whose credibility is to be influenced depends naturally on their perceptions of what features of reality (and the economic concepts used for capturing it) are most important to embody in a model. It seems that Lessons have opted for many extreme simplifications in their desire to have a simple, transparent, and readily computable version in spreadsheet form whereas Issues, as is probably inevitably the case, have taken a generally more vague but broader and less-confining approach to this issue. One gathers, however, from the applications cited in Issues, when it comes down to the practicalities of attempting concrete projects in this field, again they, perhaps unsurprisingly, opt for simplicity and pragmatic transparency in lieu of nonlinearities and other niceties (Anderson). My diffidence about throwing stones too big is traceable to the concerns of one who lives in a thinly glazed house. I have been somewhat critical of several aspects of these papers on earlier occasions (e.g., Anderson) and for brevity I will not repeat all my continuing concerns. My anxiety is that, were I pressed into empirical service for priority setting of the types discussed here, I am confident that I would be at least as guilty and thus I have to congratulate those connected with Issues and Lessons for their courage in taking on work that is so readily the target of attacks of many kinds yet, as they variously argue, must indeed be done by someone if the complex decision analysis in these processes is to be improved. Institutions that supply the resources to increasingly hard-pressed public research system (at both international and national levels) will need more formal structures of the types overviewed here to feed their own bureaucratic requirements for accountability and scrutiny. While the issues have been clearly identified in the discussion of the size of the supply shift, Jock R. Anderson is a principal economist, Agricultural Policies Division, Agriculture and Rural Development Department of the World Bank.