INTEGRATE-HTA
How to integrate apples and oranges? –
A systematic review of approaches to integrate
different dimensions in HTA
P. Wahlstera, R. Baltussenb, L. Breretonc, J. Burnsd, B. Hofmanne,
K. Mozygembaa, W. Oortwijnf, S. Polusd, E. Rehfuessd, G.J. van der Wiltb,
A. Gerhardus a
a Department for Health Services Research, University of Bremen, Bremen, Germany
b Department of Primary and Community Care, Radboud university medical center, The Netherlands
c School of Health and Related Research (ScHARR) Section of Public Health, Sheffield, United Kingdom
d Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Germany
e University of Oslo, Centre of Methical Ethics at the Institute for Health and Society at the Faculty of Medicine, Norway
f ECORYS, Health Unit, Rotterdam, The Netherlands
This project is co-funded by the European Union under the
Seventh Framework Programme (Grant Agreement No.
306141)
Definition of HTA
HTA is a “…multidisciplinary process that summarises information
about the medical, social, economic and ethical issues
related to the use of a health technology in a systematic, transparent,
unbiased, robust manner…”
(EUnetHTA n.d.)
What are the apples in HTA? What are the oranges?
philip.wahlster@uni-bremen.de
INTEGRATE-HTA
Apples and oranges in HTA of palliative care
• The variety of assessed aspects
•
Example : Hospitalization, „good death“,
continuity of care
• The assessment results
•
http://commons.wikimedia.org/wiki/File:Apple_an
d_Orange_-_they_do_not_compare.jpg?uselang=de
One decision
Example: Effectiveness: effect size for several outcome parameters like
mortality, morbidity, quality of life etc. Ethics: several identified issues like
the importance of patient autonomy in palliative care
• Context as modifying factor and factor of uncertainty
•
Example: socio-cultural factors like religion
• Values, preferences and understanding of all relevant stakeholders, including
decision-makers
philip.wahlster@uni-bremen.de
INTEGRATE-HTA
How can we achieve an integrated view on
apples and oranges?
philip.wahlster@uni-bremen.de
INTEGRATE-HTA
Aim of this study
This study aims to present a comprehensive overview of
approaches to cover different aspects of integration in HTA.
philip.wahlster@uni-bremen.de
INTEGRATE-HTA
Methods
Information sources and search
Web of Science; Medline, PsycINFO and the non-medical databases Econlit,
ASSIA, International Bibliography of the Social Sciences, Sociological abstracts
were searched from January 2004 up to April 2014.
Inclusion criteria
• Methods including multiple, quantitative or qualitative aspects
• Should include connective elements to merge criteria/ aggregate criteria/
address interdependencies between criteria
• Address aspects of the data extraction framework about integration
Exclusion criteria
• Simply side-by-side assessment, frameworks that only provide decision
criteria
philip.wahlster@uni-bremen.de
INTEGRATE-HTA
Results of search strategy
3848 Records identified after dublicates removed.
Records excluded (Different topic e.g. basic research)
2054 records assigned to the approach that was applied
30 approaches included in the synthesis.
philip.wahlster@uni-bremen.de
INTEGRATE-HTA
30 approaches:
MCDA approaches
Analytic approaches
Preference elicitation approaches
Consensus methods
Do they address…
Data extraction
philip.wahlster@uni-bremen.de
Evidence issues e.g.
effect sizes, context,
uncertainty
Judgment and
evaluation issues e.g.
values and preferences
Decision issues e.g.
comparissons to other
technologies
INTEGRATE-HTA
Extracted techniques of Integration
a.
The separation of a decision into criteria
b.
Structuring criteria
c.
Performance matrix
d.
Qualitative modelling techniques
e.
Process based integration
f.
Scoring and calculation techniques to integrate criteria
g.
Techniques as input for deliberative discussions
h.
Techniques for a structured deliberative discussion
i.
Integrating uncertainty by addressing preferences and using criteria
j.
Quantitative modelling techniques to address uncertainty of evidence
philip.wahlster@uni-bremen.de
INTEGRATE-HTA
Apples and oranges in palliative care
•
Integration of assessed aspects
•
a. The separation of a decision into criteria
•
b. Structuring criteria
•
The assessment results
•
c. Performance matrix
•
Context as modifying factor
•
d. Qualitative modelling techniques
•
Uncertainty
•
i. Integrating uncertainty by preferences and criteria
•
j. Quantitative modelling techniques to address uncertainty of evidence
http://commons.wikimedia.org/wiki/File:Apple_an
d_Orange_-_they_do_not_compare.jpg?uselang=de
One decision
• Values, preferences and understanding of all relevant stakeholders, including
decision-makers
•
•
•
e. Process based integration
f. Scoring and calculation techniques to integrate criteria
h. Techniques for a structured deliberative discussion
philip.wahlster@uni-bremen.de
INTEGRATE-HTA
Conclusion
• The results of this review provide guidance on suitable
combinations of different methods.
• All identified techniques can be used in an additive manner
as they all cover different aspects of integration.
philip.wahlster@uni-bremen.de
INTEGRATE-HTA
www.integrate-hta.eu
INTEGRATE-HTA
This project is co-funded by the European
Union under the Seventh Framework
Programme (Grant Agreement No. 306141)
Please join us at the final conference of the
INTEGRATE-HTA-Project
at 12/13 November in Amsterdam
www.integrate-hta.eu
http://www.iamsterdam.com
INTEGRATE-HTA
This project is co-funded by the European
Union under the Seventh Framework
Programme (Grant Agreement No. 306141)