136 research outputs found
Desirability–doability group judgment framework for the collaborative multicriteria evaluation of public policies
Desirability–doability framework (2 × D) is a novel framework for the collaborative evaluation of public policies. Fundamental objectives and performance indicators are agreed upon in workshops, policies are characterised, and barriers to implementation identified. MACBETH interactive protocols are then applied in decision conferences to elicit qualitative judgments about the desirability of policies, within and across objectives; and about their doability under the expected graveness of barriers on contrasting scenarios. Elicited judgments allow, respectively, to construct a shared multicriteria model measuring the overall desirability of policies; and, to measure their doability. Desirability–doability graphs enable visual interactive classification of policies, with sensitivity/robustness analyses of uncertainties. 2 × D was successfully tested in a real-world urban-health policymaking case to evaluate spatial policies. The main novelty of 2 × D is that it bridges the socio-technical gap, present in OR, between the support required by a complex social decision-making process, and that usually offered by analytic techniques – while keeping modeling theoretically sound and simple
Modelling multicriteria value interactions with Reasoning Maps
Idiographic causal maps are extensively employed in Operational Research to support problem structuring and complex decision making processes. They model means-end or causal discourses as a network of concepts connected by links denoting influence, thus enabling the representation of chains of arguments made by decision-makers. There have been proposals to employ such structures to support the structuring of multicriteria evaluation models, within an additive value measurement framework. However, a drawback of this multi-methodological modelling is the loss of richness of interactions along the means-end chains when evaluating options. This has led to the development of methods that make use of the structure of the map itself to evaluate options, such as the Reasoning Maps method, which employs ordinal scales and ordinal operators for such evaluation. However, despite their potential, Reasoning Maps cannot model explicitly value interactions nor perform a quantitative ranking of options, limiting their applicability and usefulness. In this article we propose extending the Reasoning Maps approach through a multilinear evaluation model structure, built with the MACBETH multicriteria method. The model explicitly captures the value interactions between concepts along the map and employs the MACBETH protocol of questioning to assess the strength of influence for each means-end link. The feasibility of the proposed approach to evaluate options and to deal with multicriteria interactions is tested in a real-world application to support the construction of a population health index
Avaliação do desempenho de empresas terceirizadas com o uso da metodologia multicritério de apoio à decisão - construtivista
Pairwise comparison matrices and the error-free property of the decision maker
Pairwise comparison is a popular assessment method either for deriving criteria-weights or for evaluating alternatives according to a given criterion. In real-world applications consistency of the comparisons rarely happens: intransitivity can occur. The aim of the paper is to discuss the relationship between the consistency of the decision maker—described with the error-free property—and the consistency of the pairwise comparison matrix (PCM). The concept of error-free matrix is used to demonstrate that consistency of the PCM is not a sufficient condition of the error-free property of the decision maker. Informed and uninformed decision makers are defined. In the first stage of an assessment method a consistent or near-consistent matrix should be achieved: detecting, measuring and improving consistency are part of any procedure with both types of decision makers. In the second stage additional information are needed to reveal the decision maker’s real preferences. Interactive questioning procedures are recommended to reach that goal
Valuing health states: is the MACBETH approach useful for valuing EQ-5D-3L health states?
Background
Quality Adjusted Life Years (QALYs) are a key outcome measure widely used within health technology assessment and health service research studies. QALYs combine quantity and quality of life, with quality of life calculations relying on the value of distinct health states. Such health states’ values capture the preferences of a population and have been typically built through numerical elicitation methods. Evidence points to these value scores being influenced by methods in use and individuals reporting cognitive difficulties in eliciting their preferences. Evidence from other areas has further suggested that individuals may prefer using distinct elicitation techniques and that this preference can be influenced by their numeracy. In this study we explore the use of the MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) non-numerical preference elicitation approach for health states’ evaluation.
Methods
A new protocol for preference elicitation based on MACBETH (only requiring qualitative judgments) was developed and tested within a web survey format. A sample of the Portuguese general population (n=243) valued 25 EQ-5D-3L health states with the MACBETH protocol and with a variant of the time trade-off (TTO) protocol, for comparison purposes and for understanding respondents’ preference for distinct protocols and differences in inconsistent evaluations. Respondents answered to a short numeracy test, and basic socio-economic information collected.
Results
Results show that the mean values derived from MACBETH and the TTO variant are strongly correlated; however, there are substantial differences for several health states’ values. Large and similar numbers of logical inconsistencies were found in respondents’ answers with both methods. Participants with higher levels of numeracy according to the test preferred expressing value judgments with MACBETH, while participants with lower levels were mostly indifferent to both methods. Higher correlations between MACBETH and TTO variant evaluations were observed for individuals with higher numeracy.
Conclusion
Results suggest that it is worth researching the use of non-numerical preference elicitation methods. Numeracy tests more appropriate for preference elicitation when no explicit considerations of uncertainty are made need to be explored and used. Further behavioural research is needed to fully understand the potential for using these methods in distinct settings (e.g. in different evaluation contexts and in face-to-face and non-face-to-face environments), as well as to explore the effect of literacy on assessments and on respondents’ preferences.UID/MULTI/4066/2016info:eu-repo/semantics/publishedVersio
Health-related quality of life and utilities in gastric premalignant conditions and malignant lesions: a multicentre study in a high prevalence country
BACKGROUND AND AIMS:
A recent review of economic studies relating to gastric cancer revealed that authors use different tests to estimate utilities in patients with and without gastric cancer. Our aim was to determine the utilities of gastric premalignant conditions and adenocarcinoma with a single standardized health measure instrument.
METHODS:
Cross-sectional nationwide study of patients undergoing upper endoscopy (n=1,434) using the EQ-5D-5L quality of life (QoL) questionnaire.
RESULTS:
According to EQ-5D-5L, utilities in individuals without gastric lesions were 0.78 (95% confidence interval: 0.76-0.80), with gastric premalignant conditions 0.79 (0.77-0.81), previously treated for gastric cancer 0.77 (0.73-0.81) and with present cancer 0.68 (0.55-0.81). Self-reported QoL according to the visual analogue scale (VAS) for the same groups were 0.67 (0.66-0.69), 0.67 (0.66-0.69), 0.62 (0.59-0.65) and 0.62 (0.54-0.70) respectively. Utilities were consistently lower in women versus men (no lesions 0.71 vs. 0.78; premalignant conditions 0.70 vs. 0.82; treated for cancer 0.72 vs. 0.78 and present cancer 0.66 vs. 0.70).
CONCLUSION:
The health-related QoL utilities of patients with premalignant conditions are similar to those without gastric diseases whereas patients with present cancer show decreased utilities. Moreover, women had consistently lower utilities than men. These results confirm that the use of a single standardized instrument such as the EQ-5D-5L for all stages of the gastric carcinogenesis cascade is feasible and that it captures differences between conditions and gender dissimilarities, being relevant information for authors pretending to conduct further cost-utility analysis
Advancing tools to promote health equity across European Union regions : The EURO-HEALTHY project
Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing best, which factors might shape future health outcomes and where there is room for improvement. Under the EURO-HEALTHY project, tools combining the technical elements of multi-criteria value models and the social elements of participatory processes were developed to measure health in multiple dimensions and to inform policies. The flagship tool is the Population Health Index (PHI), a multidimensional measure that evaluates health from the lens of equity in health determinants and health outcomes, further divided into sub-indices. Foresight tools for policy analysis were also developed, namely: (1) scenarios of future patterns of population health in Europe in 2030, combining group elicitation with the Extreme-World method and (2) a multi-criteria evaluation framework informing policy appraisal (case study of Lisbon). Finally, a WebGIS was built to map and communicate the results to wider audiences. The Population Health Index was applied to all European Union (EU) regions, indicating which regions are lagging behind and where investments are most needed to close the health gap. Three scenarios for 2030 were produced - (1) the 'Failing Europe' scenario (worst case/increasing inequalities), (2) the 'Sustainable Prosperity' scenario (best case/decreasing inequalities) and (3) the 'Being Stuck' scenario (the EU and Member States maintain the status quo). Finally, the policy appraisal exercise conducted in Lisbon illustrates which policies have higher potential to improve health and how their feasibility can change according to different scenarios. The article makes a theoretical and practical contribution to the field of population health. Theoretically, it contributes to the conceptualisation of health in a broader sense by advancing a model able to integrate multiple aspects of health, including health outcomes and multisectoral determinants. Empirically, the model and tools are closely tied to what is measurable when using the EU context but offering opportunities to be upscaled to other settings
Avaliação de desempenho do processo de orçamento: estudo de caso em uma obra de construção civil
Identificação das necessidades do consumidor no processo de desenvolvimento de produtos: uma proposta de inovação ilustrada para o segmento automotivo
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