Exploring the perspectives and preferences for HTA across German healthcare stakeholders using a multi-criteria assessment of a pulmonary heart sensor as a case study

BackgroundHealth technology assessment and healthcare decision-making are based on multiple criteria and evidence, and heterogeneous opinions of participating stakeholders. Multi-criteria decision analysis (MCDA) offers a potential framework to systematize this process and take different perspectives into account. The objectives of this study were to explore perspectives and preferences across German stakeholders when appraising healthcare interventions, using multi-criteria assessment of a heart pulmonary sensor as a case study.MethodsAn online survey of 100 German healthcare stakeholders was conducted using a comprehensive MCDA framework (EVIDEM V2.2). Participants were asked to provide i) relative weights for each criterion of the framework; ii) performance scores for a health pulmonary sensor, based on available data synthesized for each criterion; and iii) qualitative feedback on the consideration of contextual criteria. Normalized weights and scores were combined using a linear model to calculate a value estimate across different stakeholders. Differences across types of stakeholders were explored.ResultsThe survey was completed by 54 participants. The most important criteria were efficacy, patient reported outcomes, disease severity, safety, and quality of evidence (relative weight >0.075 each). Compared to all participants, policymakers gave more weight to budget impact and quality of evidence. The quantitative appraisal of a pulmonary heart sensor revealed differences in scoring performance of this intervention at the criteria level between stakeholder groups. The highest value estimate of the sensor reached 0.68 (on a scale of 0 to 1, 1 representing maximum value) for industry representatives and the lowest value of 0.40 was reported for policymakers, compared to 0.48 for all participants. Participants indicated that most qualitative criteria should be considered and their impact on the quantitative appraisal was captured transparently.ConclusionsThe study identified important variations in perspectives across German stakeholders when appraising a healthcare intervention and revealed that MCDA can demonstrate the value of a specified technology for all participating stakeholders. Better understanding of these differences at the criteria level, in particular between policymakers and industry representatives, is important to focus innovation aligned with patient health and healthcare system values and constraints.

[1]  Gerd Gigerenzer,et al.  Good Judgments Do Not Require Complex Cognition , 2008 .

[2]  Douglas K. Martin,et al.  Stakeholder involvement in expensive drug recommendation decisions: an international perspective. , 2012, Health policy.

[3]  A. Wailoo,et al.  Demands for ‘off‐licence’ access to trastuzumab (Herceptin): content analysis of UK newspaper articles , 2011, Health expectations : an international journal of public participation in health care and health policy.

[4]  K. Shah Severity of illness and priority setting in healthcare: a review of the literature. , 2009, Health policy.

[5]  Kurt C Stange,et al.  How Many Problems Do Family Physicians Manage at Each Encounter? A WReN Study , 2004, The Annals of Family Medicine.

[6]  R. Erbel,et al.  Heart failure: the commonest reason for hospital admission in Germany: medical and economic perspectives. , 2009, Deutsches Arzteblatt international.

[7]  R. Baltussen,et al.  Multicriteria decision analysis for including health interventions in the universal health coverage benefit package in Thailand. , 2012, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[8]  P. Oh,et al.  Bridging health technology assessment (HTA) with multicriteria decision analyses (MCDA): field testing of the EVIDEM framework for coverage decisions by a public payer in Canada , 2011, BMC health services research.

[9]  R. Baltussen,et al.  Priority setting using multiple criteria: should a lung health programme be implemented in Nepal? , 2007, Health policy and planning.

[10]  S. Gabriel,et al.  Systematic Review of the Literature , 2021, Adherence to Antiretroviral Therapy among Perinatal Women in Guyana.

[11]  C. Deal,et al.  Combining multicriteria decision analysis, ethics and health technology assessment: applying the EVIDEM decisionmaking framework to growth hormone for Turner syndrome patients , 2010, Cost effectiveness and resource allocation : C/E.

[12]  A. Hoes,et al.  Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. , 2005, European heart journal.

[13]  R. Baltussen,et al.  Multi-criteria decision analysis to prioritize health interventions: Capitalizing on first experiences. , 2010, Health policy.

[14]  M. Petticrew,et al.  The Public Health Responsibility Deal: how should such a complex public health policy be evaluated? , 2013, Journal of public health.

[15]  R. Armstrong,et al.  Essential components of public health evidence reviews: capturing intervention complexity, implementation, economics and equity. , 2011, Journal of public health.

[16]  G. Barton,et al.  Randomised controlled trial , 2016 .

[17]  R. Bourge,et al.  Comparison of a radiofrequency-based wireless pressure sensor to swan-ganz catheter and echocardiography for ambulatory assessment of pulmonary artery pressure in heart failure. , 2007, Journal of the American College of Cardiology.

[18]  Anna Strömberg,et al.  ESC GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC HEART FAILURE 2008 (ENDING) , 2009 .

[19]  Philip Adamson,et al.  Continuous ambulatory right heart pressure measurements with an implantable hemodynamic monitor: a multicenter, 12-month follow-up study of patients with chronic heart failure. , 2002, Journal of cardiac failure.

[20]  K. Kieslich Social values and health priority setting in Germany. , 2012, Journal of health organization and management.

[21]  Rob Baltussen,et al.  Multi-criteria decision analysis for setting priorities on HIV/AIDS interventions in Thailand , 2012, Health Research Policy and Systems.

[22]  Gerd Gigerenzer,et al.  Why do single event probabilities confuse patients? , 2012, BMJ : British Medical Journal.

[23]  Matthew J. Liberatore,et al.  The analytic hierarchy process in medical and health care decision making: A literature review , 2008, Eur. J. Oper. Res..

[24]  P. Wahlster,et al.  Identifying stakeholder opinion regarding access to “high-cost medicines”: A systematic review of the literature , 2014 .

[25]  T. Stargardt,et al.  Early Benefit Assessment of Pharmaceuticals in Germany , 2014, Medical decision making : an international journal of the Society for Medical Decision Making.

[26]  A. Colman,et al.  Optimal number of response categories in rating scales: reliability, validity, discriminating power, and respondent preferences. , 2000, Acta psychologica.

[27]  T. Neumann,et al.  Heart Failure: the Commonest Reason for Hospitalization in Germany—Medical and Economic Perspectives: In reply , 2009 .

[28]  W. Abraham Disease management: remote monitoring in heart failure patients with implantable defibrillators, resynchronization devices, and haemodynamic monitors. , 2013, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[29]  Keun-Tae Cho,et al.  Selecting medical devices and materials for development in Korea: the analytic hierarchy process approach. , 2003, The International journal of health planning and management.

[30]  Paul Kind,et al.  WHICH CRITERIA ARE CONSIDERED IN HEALTHCARE DECISIONS? INSIGHTS FROM AN INTERNATIONAL SURVEY OF POLICY AND CLINICAL DECISION MAKERS , 2013, International Journal of Technology Assessment in Health Care.

[31]  Renato Pietro Ricci,et al.  Telemedicine and cardiac implants: what is the benefit? , 2012, European heart journal.

[32]  Gary E. Day,et al.  Redefining Health Care: Creating Value-Based Competition on Results , 2006 .

[33]  Zoltán Kaló,et al.  Multiple Criteria Decision Analysis for Health Care Decision Making--Emerging Good Practices: Report 2 of the ISPOR MCDA Emerging Good Practices Task Force. , 2016, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[34]  Elly Stolk,et al.  Towards a multi-criteria approach for priority setting: an application to Ghana. , 2006, Health economics.

[35]  Michaël Lauer,et al.  Book Review Redefining Health Care: Creating Value-Based Competition on Results By Michael E. Porter and Elizabeth Olmsted Teisberg. 506 pp. Boston, Harvard Business School Press, 2006. $35. 978-1-59139-778-6 , 2006 .

[36]  V. Diaby,et al.  PRM12 An Application of a Proposed Framework for Formulary Listing in Low-income Countries: Case of Côte d'Ivoire , 2011 .

[37]  William T. Abraham,et al.  Physician-Directed Patient Self-Management of Left Atrial Pressure in Advanced Chronic Heart Failure , 2010, Circulation.

[38]  L. A. Bonet,et al.  ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 , 2012, Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir.

[39]  R. Baltussen,et al.  Priority setting of health interventions: the need for multi-criteria decision analysis , 2006, Cost effectiveness and resource allocation : C/E.

[40]  Angela Coulter,et al.  What do patients and the public want from primary care? , 2005, BMJ : British Medical Journal.

[41]  N. Daniels,et al.  The ethics of accountability in managed care reform. , 1998, Health affairs.

[42]  M. Zile,et al.  Randomized controlled trial of an implantable continuous hemodynamic monitor in patients with advanced heart failure: the COMPASS-HF study. , 2008, Journal of the American College of Cardiology.

[43]  Tamara Kredo,et al.  Clinical practice guidelines within the Southern African development community: a descriptive study of the quality of guideline development and concordance with best evidence for five priority diseases , 2012, Health Research Policy and Systems.

[44]  N. Daniels,et al.  Accountability for reasonableness. , 2000, BMJ.

[45]  D. Richel,et al.  Cost issues in new disease-modifying treatments for advanced cancer: in-depth interviews with physicians. , 2007, European journal of cancer.

[46]  W. Gaissmaier,et al.  Numbers can be worth a thousand pictures: individual differences in understanding graphical and numerical representations of health-related information. , 2012, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[47]  Vakaramoko Diaby,et al.  An application of a proposed framework for formulary listing in low-income countries , 2011, Applied health economics and health policy.

[48]  M. Goetghebeur,et al.  Field testing of a multicriteria decision analysis (MCDA) framework for coverage of a screening test for cervical cancer in South Africa , 2012, Cost Effectiveness and Resource Allocation.

[49]  P. Ubel,et al.  In a survey, marked inconsistency in how oncologists judged value of high-cost cancer drugs in relation to gains in survival. , 2012, Health affairs.

[50]  D. Kalanovic,et al.  Patient relevant endpoints in oncology: current issues in the context of early benefit assessment in Germany , 2014, Health Economics Review.

[51]  P. Rickenbacher Herzinsuffizienz: Epidemiologie, Pathophysiologie , 2001 .

[52]  Steven Simoens,et al.  Paying for the Orphan Drug System: break or bend? Is it time for a new evaluation system for payers in Europe to take account of new rare disease treatments? , 2012, Orphanet Journal of Rare Diseases.

[53]  L. Erickson,et al.  Evidence and Value: Impact on DEcisionMaking – the EVIDEM framework and potential applications , 2008, BMC health services research.

[54]  A. Valle,et al.  Diffusion of nuclear energy in some developing countries , 2014 .

[55]  Ron Waksman,et al.  Overview of the 2011 Food and Drug Administration Circulatory System Devices Panel of the Medical Devices Advisory Committee Meeting on the CardioMEMS Champion Heart Failure Monitoring System. , 2013, Journal of the American College of Cardiology.

[56]  Gerd Gigerenzer,et al.  Cognitive Processes in Decisions Under Risk are not the Same as in Decisions Under Uncertainty , 2012, Front. Neurosci..

[57]  P. Ponikowski,et al.  Population of Polish patients participating in the Heart Failure Pilot Survey (ESC-HF Pilot). , 2013, Kardiologia polska.

[58]  Jon Sussex,et al.  A pilot study of multicriteria decision analysis for valuing orphan medicines. , 2013, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[59]  Ian Robinson,et al.  Developing medical device technologies from users' perspectives: A theoretical framework for involving users in the development process , 2009, International Journal of Technology Assessment in Health Care.

[60]  Hanane Khoury,et al.  Bridging Health Technology Assessment (HTA) and Efficient Health Care Decision Making with Multicriteria Decision Analysis (MCDA) , 2012, Medical decision making : an international journal of the Society for Medical Decision Making.

[61]  Charles Acquah,et al.  Balancing equity and efficiency in health priorities in Ghana: the use of multicriteria decision analysis. , 2008, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[62]  L. Stevenson,et al.  Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial , 2011, The Lancet.

[63]  Maarten J. IJzerman,et al.  The Use of Multi-Criteria Decision Analysis Weight Elicitation Techniques in Patients with Mild Cognitive Impairment , 2008, The patient.

[64]  Cristina Masella,et al.  IMPLEMENTATION OF EUNETHTA CORE MODEL® IN LOMBARDIA: THE VTS FRAMEWORK , 2014, International Journal of Technology Assessment in Health Care.

[65]  Reinhard German,et al.  Technology foresight for medical device development through hybrid simulation: The ProHTA Project , 2015 .

[66]  F. Follath,et al.  One-year mortality among unselected outpatients with heart failure. , 2002, European heart journal.

[67]  J. Geddes,et al.  What is a randomised controlled trial? , 2009, Epidemiologia e Psichiatria Sociale.

[68]  Norman Daniels,et al.  Accountability for reasonableness , 2000, BMJ : British Medical Journal.

[69]  Katie Page,et al.  The four principles: Can they be measured and do they predict ethical decision making? , 2012, BMC Medical Ethics.

[70]  W. Wijns,et al.  Chronic monitoring of pulmonary artery pressure in patients with severe heart failure: multicentre experience of the monitoring Pulmonary Artery Pressure by Implantable device Responding to Ultrasonic Signal (PAPIRUS) II study , 2009, Heart.

[71]  J. Robertson,et al.  Medicines and the media: news reports of medicines recommended for government reimbursement in Australia , 2013, BMC Public Health.