Online Resource 3: Classification of Healthcare Funding Decision Criteria
Guindo et.al.a aimed to identify the decision criteria (and their frequency) considered by public
funding decision-makers when evaluating healthcare interventions, based on evaluation of the
healthcare decision-making literature. Decision criteria were extracted and organized using a
classification system base on the EVIDEM framework,b from studies of several world regions and
involving decision-making at the micro, meso and macro levels. Frequency of mention (counts) were
measured based on frequency of occurrence in the literature. Guindo identified 360 different terms
used in public funding decision-making, which were assigned to 58 criteria and classified into 9
categories, shown in the table below.
Our focus is on the criteria considered by public payers making funding decisions for new highcost cancer drugs. After searching the literature for classification schemes, we found Guindo’s
classification was the most recent and comprehensive fit for our pusposes. Our study examines the
criteria considered by public payers for only a subset of Guindo’s criteria:
(i) we are considering only the funding criteria, and not the process.
(ii) we are considering only the ‘macro level’ (funding decision-maker), and not considering the
factors considered at the meso level (healthcare facility) or micro level (healthcare provider).
Therefore, several of Guindo’s criteria do not apply to our study, and are shaded: C3, D4, E4, F5, G14, G6, G8, H5, I1, I2, I4, I6, I7, I9, I10.
Categories of classification system
A-Health outcomes and benefits of intervention
B-Type of health benefit
C-Impact of the disease targeted by intervention
D-Therapeutic context of intervention
E-Economic impact of intervention
Coding
A1
A2
A3
A4
A5
B1
B2
C1
C2
C3
C4
D1
D2
D3
D4
E1
Funding Criteria
Health benefits
Efficacy/effectiveness
Life saving
Safety
PRO
Population Effect
Individual effect
Disease Severity
Disease Determinants
Disease Burden
Epidemiology
Treatment alternatives
Need
Practice Guidelines
Pre-existing use
Costs
F-Evidence Quality & Uncertainty
G- Implementation: complexity of intervention
H-Priorities fairness and ethics
I-Overall context
E2
E3
E4
E5
E6
E7
E8
E9
F1
F2
F3
F4
F5
F6
G1
G2
G3
G4
G5
G6
G7
G8
H1
H2
H3
H4
H5
H6
H7
I1
I2
I3
I4
I5
I6
I7
I8
I9
I10
I11
Budget Impact
Broad Financial Impact
Poverty Reduction
Cost-effectiveness
Value
Efficiency & opportunity costs
Resources
Insurance Premiums
Evidence Available
Strength of Evidence
Relevance of evidence
Evidence characteristics
Research Ethics
Evidence requirements
Legislation
Organiational requirements
Skills
Flexibility of Implementation
Characteristics of intervention
Appropriate Use
Integration & System efficiencies
Population Priorities
Access to Treatment
Vulnerable & needy population
Equity, fairness and justice
Utility
Solidarity
Ethics and moral aspects
Mission and Mandate
Overall Priorities
Financial constraints
Incentives
Political Aspects
Historical Aspects
Cultural Aspects
Innovation
Partnership and leadership
Citizen involvement
Stakeholders interests and pressures
Title and Abstract screening
Included studies where:
(i)
the intervention was a cancer treatment,
(ii)
study subjects were cancer patients, the general public, or public payers,
(iii)
study design included a predefined measure of preference, and
(iv)
study outcome measures included attributes or measures of value, using domains and
metrics relevant to cancer. [19][20]
and excluded if:
(i)
narrative reviews,
(ii)
studies with outcome measures lacking attributes or measures of value,
(iii)
studies not assessing cancer drug funding preferences,
(iv)
studies reporting interim/duplicate results later published.
Initial abstract screening reduced our sample to 107 studies; full-text review left 20 studies.
Screening of secondary references from eligible studies yielded two additional studies, for a total of
22 studies.
a
Guindo LA, Wagner M, Baltussen R, et.al. From efficacy to equity: Literature review of decision criteria for
resource allocation and healthcare decisionmaking. Cost Effectiveness and Resource Allocation; 2012;10:9
b
Evidence and Value Impact on DEcision Making. The EVIDEM framework was designed to evaluate
healthcare interventions and facilitate their prioritization using a comprehensive set of universal and
contextual decision criteria organized into pragmatic tools. The framework and its tools are regularly updated
by active members of the collaboration. www.evidem.org/evidem-overview.php