From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking

Objectives Resource allocation is a challenging issue faced by health policy decisionmakers requiring careful consideration of many factors. Objectives of this study were to identify decision criteria and their frequency reported in the literature on healthcare decisionmaking. Method An extensive literature search was performed in Medline and EMBASE to identify articles reporting healthcare decision criteria. Studies conducted with decisionmakers (e.g., focus groups, surveys, interviews), conceptual and review articles and articles describing multicriteria tools were included. Criteria were extracted, organized using a classification system derived from the EVIDEM framework and applying multicriteria decision analysis (MCDA) principles, and the frequency of their occurrence was measured. Results Out of 3146 records identified, 2790 were excluded. Out of 356 articles assessed for eligibility, 40 studies included. Criteria were identified from studies performed in several regions of the world involving decisionmakers at micro, meso and macro levels of decision and from studies reporting on multicriteria tools. Large variations in terminology used to define criteria were observed and 360 different terms were identified. These were assigned to 58 criteria which were classified in 9 different categories including: health outcomes; types of benefit; disease impact; therapeutic context; economic impact; quality of evidence; implementation complexity; priority, fairness and ethics; and overall context. The most frequently mentioned criteria were: equity/fairness (32 times), efficacy/effectiveness (29), stakeholder interests and pressures (28), cost-effectiveness (23), strength of evidence (20), safety (19), mission and mandate of health system (19), organizational requirements and capacity (17), patient-reported outcomes (17) and need (16). Conclusion This study highlights the importance of considering both normative and feasibility criteria for fair allocation of resources and optimized decisionmaking for coverage and use of healthcare interventions. This analysis provides a foundation to develop a questionnaire for an international survey of decisionmakers on criteria and their relative importance. The ultimate objective is to develop sound multicriteria approaches to enlighten healthcare decisionmaking and priority-settin

A Parallel Monte-Carlo Tree Search-Based Metaheuristic For Optimal Fleet Composition Considering Vehicle Routing Using Branch & Bound

In this paper, a Monte-Carlo Tree Search (MCTS)-based metaheuristic is developed that guides a Branch & Bound (B&B) algorithm to find the globally optimal solution to the heterogeneous fleet composition problem while considering vehicle routing. Fleet Size and Mix Vehicle Routing Problem with Time Windows (FSMVRPTW). The metaheuristic and exact algorithms are implemented in a parallel hybrid optimization algorithm where the metaheuristic rapidly finds feasible solutions that provide candidate upper bounds for the B&B algorithm which runs simultaneously. The MCTS additionally provides a candidate fleet composition to initiate the B&B search. Experiments show that the proposed approach results in significant improvements in computation time and convergence to the optimal solution.Comment: Submitted to the IEEE Intelligent Vehicles Symposium 202

Cost effectiveness of strategies to combat breast, cervical, and colorectal cancer in sub-Saharan Africa and South East Asia: mathematical modelling study

Objective To determine the costs and health effects of interventions to combat breast, cervical, and colorectal cancers in order to guide resource allocation decisions in developing countries

Development of the WHO-INTEGRATE evidence-to-decision framework: an overview of systematic reviews of decision criteria for health decision-making

Background Decision-making in public health and health policy is complex and requires careful deliberation of many and sometimes conflicting normative and technical criteria. Several approaches and tools, such as multi-criteria decision analysis, health technology assessments and evidence-to-decision (EtD) frameworks, have been proposed to guide decision-makers in selecting the criteria most relevant and appropriate for a transparent decision-making process. This study forms part of the development of the WHO-INTEGRATE EtD framework, a framework rooted in global health norms and values as reflected in key documents of the World Health Organization and the United Nations system. The objective of this study was to provide a comprehensive overview of criteria used in or proposed for real-world decision-making processes, including guideline development, health technology assessment, resource allocation and others. Methods We conducted an overview of systematic reviews through a combination of systematic literature searches and extensive reference searches. Systematic reviews reporting criteria used for real-world health decision-making by governmental or non-governmental organization on a supranational, national, or programme level were included and their quality assessed through a bespoke critical appraisal tool. The criteria reported in the reviews were extracted, de-duplicated and sorted into first-level (i.e. criteria), second-level (i.e. sub-criteria) and third-level (i.e. decision aspects) categories. First-level categories were developed a priori using a normative approach; second- and third-level categories were developed inductively. Results We included 36 systematic reviews providing criteria, of which one met all and another eleven met at least five of the items of our critical appraisal tool. The criteria were subsumed into 8 criteria, 45 sub-criteria and 200 decision aspects. The first-level of the category system comprised the following seven substantive criteria: \textquotedblHealth-related balance of benefits and harms\textquotedbl; \textquotedblHuman and individual rights\textquotedbl; \textquotedblAcceptability considerations\textquotedbl; \textquotedblSocietal considerations\textquotedbl; \textquotedblConsiderations of equity, equality and fairness\textquotedbl; \textquotedblCost and financial considerations\textquotedbl; and \textquotedblFeasibility and health system considerations\textquotedbl. In addition, we identified an eight criterion \textquotedblEvidence\textquotedbl. Conclusion This overview of systematic reviews provides a comprehensive overview of criteria used or suggested for real-world health decision-making. It also discusses key challenges in the selection of the most appropriate criteria and in seeking to implement a fair decision-making process

Interaction Design and User Needs for TV Broadcasts Enriched with Linked Open Data

Increasingly, people are consuming television content on devices connected to the Internet that allow them to look up related information. In parallel, Europe is publishing growing amounts of Linked Open Data, including rich metadata about its cultural heritage. The goal of the LinkedTV project is to seamlessly interlink TV and Web content to enrich the user’s experience of both. Linked Data and semantic technologies enable broadcasters to achieve added value for their content at low cost through the re-use of existing metadata. We present two user studies related to different user scenarios: Interactive News and Hyperlinked Documentary). These studies reveal the different user requirements and infor

Criteria for priority setting of HIV/AIDS interventions in Thailand: a discrete choice experiment

Contains fulltext : 87849.pdf (publisher's version ) (Open Access)BACKGROUND: Although a sizeable budget is available for HIV/AIDS control in Thailand, there will never be enough resources to implement every programme for all target groups at full scale. As such, there is a need to prioritize HIV/AIDS programmes. However, as of yet, there is no evidence on the criteria that should guide the priority setting of HIV/AIDS programmes in Thailand, including their relative importance. Also, it is not clear whether different stakeholders share similar preferences. METHODS: Criteria for priority setting of HIV/AIDS interventions in Thailand were identified in group discussions with policy makers, people living with HIV/AIDS (PLWHA), and community members (i.e. village health volunteers (VHVs)). On the basis of these, discrete choice experiments were designed and administered among 28 policy makers, 74 PLWHA, and 50 VHVs. RESULTS: In order of importance, policy makers expressed a preference for interventions that are highly effective, that are preventive of nature (as compared to care and treatment), that are based on strong scientific evidence, that target high risk groups (as compared to teenagers, adults, or children), and that target both genders (rather than only men or women). PLWHA and VHVs had similar preferences but the former group expressed a strong preference for care and treatment for AIDS patients. CONCLUSIONS: The study has identified criteria for priority setting of HIV/AIDS interventions in Thailand, and revealed that different stakeholders have different preferences vis-a-vis these criteria. This could be used for a broad ranking of interventions, and as such as a basis for more detailed priority setting, taking into account also qualitative criteria