Monday, July 30, 2012

[EQ] From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking

From efficacy to equity:
Literature review of decision criteria for resource allocation and healthcare decisionmaking

Guindo LA, Wagner M, Baltussen R, Rindress D, van Til J, Kind P, Goetghebeur MM
Cost effectiveness and resource allocation : C/E. 2012 Jul 18; vol. 10(1)

Available online PDF [27p.] at:

Resource allocation is a challenging issue faced by health policy decisionmakers requiring careful consideration of many factors.
Objectives of this study were to identify decision criteria reported in the literature on healthcare decisionmaking.

An extensive literature search was performed in Medline and EMBASE to identify articles reporting healthcare decision criteria. Studies conducted with decisionmakers (e.g., focus groups, surveys, interviews), conceptual and review articles and articles describing tools were included. Criteria were extracted, organized using a classification system derived from the EVIDEM framework and applying multicriteria decision analysis (MCDA) principles, and the frequency of their occurrence was measured.

Out of 3146 records identified, 2790 were excluded. Out of 356 articles assessed for eligibility, 39 were included in the study. Criteria were identified from studies performed in several regions of the world involving decisionmakers at micro, meso and macro levels of decision and from studies reporting on multicriteria tools. Large variations in terminology used to define criteria were observed and 338 different terms were identified.

These were assigned to 58 criteria which were classified in 9 different categories including: health outcomes; types of benefit; disease impact; therapeutic context; economic impact; quality of evidence; implementation complexity; priority, fairness and ethics; and overall context.
The most frequently mentioned criteria were:
equity/fairness (33 times),
efficacy/effectiveness (28),
healthcare stakeholder interests and pressures (28),
cost-effectiveness (24),
strength of evidence (20),
safety (19),
mission and mandate of health system (18),
need (16),
organizational requirements and capacity (18) and
patient-reported outcomes (16).

This study highlights the importance of considering both normative and feasibility criteria for fair allocation of resources and optimized decisionmaking for coverage and use of healthcare interventions. This analysis provides a foundation to develop a questionnaire for an international survey of decisionmakers on criteria and their relative importance. The ultimate objective is to develop sound multicriteria approaches to enlighten healthcare decisionmaking and priority-setting.


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