The past and future of the AHP in health care decision making

Objective. Health care decision making is a complex process involving many stakeholders and allowing for multiple decision criteria. The Analytic Hierarchy process (AHP) can support these complex decisions that relate to the application and coverage of health care technologies. The objective of this study is to review the past applications of the AHP in supporting health care decision making, and to make recommendations for its future use.\ud Method. We conducted a systematic review of AHP applications in health care, as described in the relevant medical, health-economical, psycho-sociological, managerial, and applied mathematical literature.\ud Results. We found 62 distinctive AHP applications in health care. Of the retrieved applications, 13 % focus on shared decision-making between patient and clinician, 27 % on the development of clinical practice guidelines, 5 % on the development of medical devices and pharmaceuticals, 40 % on management decisions in health care organizations, and 15 % on the development of national health care policy.\ud Conclusions. From the review it is concluded that the AHP is suitable to apply in case of complex health care decision problems, a need to improve decision making in stead of explain decision outcomes, a need to share information among experts or between clinicians and patients, and in case of a limited availability of informed respondents. We foresee the increased use of the AHP in health economical assessment of technology

Assessment of the added value of the Twente Photoacoustic Mammoscope in breast cancer diagnosis\ud

Purpose: Photoacoustic (PA) imaging is a recently developed breast cancer imaging technique. In order to enhance successful clinical implementation, we quantified the potential clinical value of different scenarios incorporating PA imaging by means of multi-criteria analysis. From this analysis, the most promising area of application for PA imaging in breast cancer diagnosis is determined, and recommendations are provided to optimize the design of PA imaging. - \ud Methods: The added value of PA imaging was assessed in two areas of application in the diagnostic track. These areas include PA imaging as an alternative to x-ray mammography and ultrasonography in early stage diagnosis, and PA imaging as an alternative to Magnetic Resonance Imaging (MRI) in later stage diagnosis. The added value of PA imaging was assessed with respect to four main criteria (costs, diagnostic performance, patient comfort and risks). An expert panel composed of medical, technical and management experts was asked to assess the relative importance of the criteria in comparing the alternative diagnostic devices. The judgments of the experts were quantified based on the validated pairwise comparison technique of the Analytic Hierarchy Process, a technique for multi-criteria analysis. Sensitivity analysis was applied to account for the uncertainty of the outcomes. - \ud Results: Among the considered alternatives, PA imaging is the preferred technique due to its non-invasiveness, low cost and low risks. However, the experts do not expect large differences in diagnostic performance. The outcomes suggest that design changes to improve the diagnostic performance of PA imaging should focus on the quality of the reconstruction algorithm, detector sensitivity, detector bandwidth and the number of wavelengths used. - \ud Conclusion: The AHP method was useful in recommending the most promising area of application in the diagnostic track for which PA imaging can be implemented, this being early diagnosis, as a substitute for the combined use of x-ray mammography and ultrasonography

Integrating patients' views into health technology assessment: Analytic hierarchy process (AHP) as a method to elicit patient preferences

Background: Patient involvement is widely acknowledged to be a valuable component in health technology assessment (HTA) and healthcare decision making. However, quantitative approaches to ascertain patients' preferences for treatment endpoints are not yet established. The objective of this study is to introduce the analytic hierarchy process (AHP) as a preference elicitation method in HTA. Based on a systematic literature review on the use of AHP in health care in 2009, the German Institute for Quality and Efficiency in Health Care (IQWiG) initiated an AHP study related to its HTA work in 2010. - \ud Methods: The AHP study included two AHP workshops, one with twelve patients and one with seven healthcare professionals. In these workshops, both patients and professionals rated their preferences with respect to the importance of different endpoints of antidepressant treatment by a pairwise comparison of individual endpoints. These comparisons were performed and evaluated by the AHP method and relative weights were generated for each endpoint. - \ud Results: The AHP study indicates that AHP is a well-structured technique whose cognitive demands were well handled by patients and professionals. The two groups rated some of the included endpoints of antidepressant treatment differently. For both groups, however, the same six of the eleven endpoints analyzed accounted for more than 80 percent of the total weight. - \ud Conclusions: AHP can be used in HTA to give a quantitative dimension to patients' preferences for treatment endpoints. Preference elicitation could provide important information at various stages of HTA and challenge opinions on the importance of endpoints

Integrating patient preferences in efficiency frontier analyses using the analytical hierarchy process

OBJECTIVES: In comparative effectiveness research and economic evaluations, benefits of technologies are measured using multiple outcomes measures. Information lacks however about the importance of these endpoints for patients. We propose a new methodology to integrate patient weighted outcomes in a cost-efficiency frontier. We illustrate this methodology by means of an efficiency frontier analysis of five alternative treatments of patients with equinovarus deformity poststroke. METHODS: The Analytic Hierarchy Process (AHP) is a technique for multi-criteria analysis. The AHP supported 140 patients to prioritize the outcome measures of treatments of equinovarus deformity poststroke, and 10 professionals to prioritize the treatments regarding the outcome measures. These outcome measures include functional outcomes, risk and side effects, comfort, daily effort, cosmetics, and impact of the treatment. Sensitivity analysis is based on bootstrapping of the participants’ priorities. Relative costs include the device related costs and the care related costs of the treatments. RESULTS: The overall effectiveness of soft-tissue surgery (.41) is ranked first, followed by orthopedic footwear (.18), ankle-footorthosis (.15), surface electrostimulation (.14), and finally implanted electrostimulation (.12). Implanted electrostimulation (.35) and soft-tissue surgery (.34) are considered to be most expensive, followed by surface electrostimulation (.26), orthopedic footwear (.03) and ankle-foot orthosis (.02). Based on these priorities of the treatments’ overall effectiveness and costs, an efficiency frontier was drawn that includes decision uncertainty. CONCLUSIONS: The results suggest that the cost-effectiveness of implanted electrostimulation and surface electrostimulation are unfavourable. This new methodology for efficiency frontier analysis allows decision makers to integrate the outcomes about the diverse values and costs of health care technology, and can be applied broadly. It is particularly suitable in the field of early technology assessment, since the AHP supports a systematic estimation of priors about the effectiveness of alternative treatments

PCN94 - Cost-effectiveness and preference for follow-up scenarios following breast cancer

OBJECTIVES: About one in every eight women in The Netherlands develops breast cancer. Every year, 11,000 new cases are registered and about 3500 women die of breast cancer. Prognosis after primary treatment for patients with breast cancer is improving. This leads to an increased number of patients in follow-up, which leads to increased workload. One of the main goals of follow-up is to improve the survival of patients. This study aims to determine a more individualized follow-up by modelling costeffectiveness of various follow-up scenarios and by determining individual preferences by using a discrete choice experiment (DCE). METHODS: A discrete-event state-transition model was developed to estimate the cost-effectiveness of all scenarios for all patient groups. In addition, a discrete choice experiment (DCE) was designed to establish patient preferences. The DCE incorporated three process attributes (duration of follow-up, frequency and type of consult) and data were collected in a sample of 125 breast cancer patients. Patients had to complete all 18 choice sets that were generated from the three attributes. RESULTS: The modelling study revealed recommendations for follow-up in different age categories. Patients younger than 40 and patients with unfavorable tumor characteristics (>3 lymph nodes, tumor size >2 cm) can benefit from a more intensive follow-up of five or possibly ten years. Patients older than 40 but younger than 70 years old sometimes benefit from a more intensive follow-up; e.g. when younger than 50 and tumor size >2 cm. The DCE, however, showed that patients chose maximum levels of follow-up independent from age and their individual clinical risk profile. Duration of follow-up and type of consult (either hospital visit or telephone) weighted approximately 0.43 and 0.50 respectively. The frequency of follow-up (either once or twice a year) was least important (0.07). CONCLUSIONS: The model showed that follow-up may be individualized according to risk profile and age. However, patients preferred long and intensive follow-up strategies after breast cancer treatment. Taking into account individual patient preferences it may be recommended to reduce the frequency of follow-up to once a year. The service delivery by nurse practioners is well appreciated and another means for improving cost-effective follow-up

Applying the AHP in Health Economic Evaluations of New Technology.

Much research in health care is devoted to health economical modelling. Even though the Analytic Hierarchy Process (AHP) is increasingly being applied in health care, its value to health economical modelling is still unrecognized. We explored the value of using AHP-derived results in a health economic model. We applied the AHP to provide input for a health economic evaluation of a new technology to diagnose breast cancer. No clinical data were available about the sensitivity and specificity of this technology. By means of the AHP, an expert panel estimated the sensitivity and specificity to be used in this model. Moreover, additional criteria including patient comfort and risks could be added to the health economic model. On the basis of the methodology suggested, the AHP proved to be feasible to support a comprehensive health economical evaluation of new technology, where clinical evidence is not yet available, or incomplet

A Review and Classification of Approaches for Dealing with Uncertainty in Multi-Criteria Decision Analysis for Healthcare Decisions

The Author(s) 2015. This article is published with open access at Springerlink.com Abstract Multi-criteria decision analysis (MCDA) is increasingly used to support decisions in healthcare involving multiple and conflicting criteria. Although uncertainty is usually carefully addressed in health eco-nomic evaluations, whether and how the different sources of uncertainty are dealt with and with what methods in MCDA is less known. The objective of this study is to review how uncertainty can be explicitly taken into account in MCDA and to discuss which approach may be appro-priate for healthcare decision makers. A literature review was conducted in the Scopus and PubMed databases. Two reviewers independently categorized studies according to research areas, the type of MCDA used, and the approach used to quantify uncertainty. Selected full text articles wer