Creating a priority list of non-communicable diseases to support health research funding decision-making

Objective To develop and pilot a framework based on multi-criteria decision analysis (MCDA) to prioritize non-communicable diseases (NCDs) to support health research funding decision-making. Methods The framework involves identifying NCDs to be prioritized, specifying prioritization criteria and determining their weights from a survey of stakeholders. The mean weights from the survey are applied to the NCDs’ ratings on the criteria to generate a ‘total score’ for each NCD, by which the NCDs are prioritized. Results Nineteen NCDs and five criteria were included. The criteria, in decreasing order of importance (mean weights in parentheses), are: deaths across the population (27.7 %), loss of quality-of-life across the population (23.0 %), cost to patients and families (18.6 %), cost to the health system (17.2 %), and whether vulnerable groups are disproportionately affected (13.4 %). The priority list of NCDs, stratified into four tiers of importance, is: ‘Very critical’ priority: coronary heart disease, back and neck pain, diabetes mellitus; ‘Critical’ priority: dementia and Alzheimer’s disease, stroke; ‘High’ priority: colon and rectum cancer, depressive disorders, chronic obstructive pulmonary disease, chronic kidney disease, breast cancer, prostate cancer, arthritis, lung cancer; and ‘Medium’ priority: asthma, hearing loss, melanoma skin cancer, addictive disorders, non-melanoma skin cancer, headaches. Conclusion The results indicate the framework for prioritizing NCDs for research funding is feasible and effective. The framework could also be used for other health conditions

Using multi-criteria decision analysis (MCDA) to support health research funding decision-making

There is a growing body of literature using multi-criteria decision analysis (MCDA) methods for prioritising health interventions. However, there has been very little application of MCDA to prioritise funding for research across health conditions, including non-communicable diseases (NCDs). NCDs are non-transmissible diseases that are not spread from person to person – e.g. diabetes mellitus, coronary heart disease, back pain, dementia and depression. Given limited resources, funding needs to be systematically allocated for research into the most pressing NCDs by explicitly identifying priorities for health research. Methods based on MCDA have attracted increasing attention by policy-makers and researchers by systematically forming and solving the multi-dimensional aspects of the decision problems, particularly in the health system. This thesis aims to investigate the use of MCDA to support health research funding across NCDs. Following chapters of introduction and a review of commonly used methods, the thesis includes three main chapters (i.e. Chapters 3, 4 and 5), as well as the concluding chapter that provides policy implications and research contributions of the thesis. In Chapter 3, a widely-used MCDA method – i.e. the Potentially All Pairwise RanKings of all possible Alternatives (PAPRIKA) method administered through 1000minds software – is applied to create a priority list of NCDs to support health research funding. Informed by the literature, a set of prioritisation criteria – e.g. deaths, loss of quality-of-life and cost of the disease – is specified to evaluate NCDs in terms of their priority for health research funding decision-making. Their weights, representing their relative importance, are calculated based on a survey of stakeholders from various sectors of the New Zealand (NZ) health system. The most important criterion for prioritising NCDs in terms of their overall burden to society (and hence their importance for health research funding) is ‘deaths across the population’ (mean weight = 27.7%), followed by ‘loss of quality-of-life across the population’ (23.0%), then ‘cost of the disease to patients and families’ (18.6%), ‘cost of the disease to the health system’ (17.2%) and the least-important criterion, ‘disproportionately affects vulnerable groups’ (13.4%). The criteria are used to rate NCDs based on evidence concerning their performance on the criteria. The rated NCDs are then ranked using the criteria mean weights from the survey. Each NCD’s total score is presented based on a 0-100% scale, where 100% indicated an NCD with the highest levels on all criteria, and 0%, an NCD with the lowest levels on all criteria. The NCDs ranking is categorised into four tiers: Priority 1 (very critical): coronary heart disease, back and neck pain, diabetes mellitus; Priority 2 (critical): dementia and Alzheimer’s disease, stroke; Priority 3 (high): colon and rectum cancer, depressive disorders, chronic obstructive pulmonary disease, chronic kidney disease, breast cancer, prostate cancer, arthritis, lung cancer; Priority 4 (medium): asthma, hearing loss, melanoma skin cancer, addictive disorders, non-melanoma skin cancer, headaches. The MCDA-based framework developed in Chapter 3 enables incorporating multiple criteria for evaluating a range of NCDs in terms of their priority for research funding and the involvement of a diverse range of stakeholders. This framework is hence more likely to generate a priority list that is more acceptable to the key stakeholders. This priority list shows that it is essential to incorporate the multi-dimensional nature – e.g. mortality, morbidity and health care costs – of NCDs when evaluating their priority and eligibility for health research funding. In Chapter 4, PAPRIKA is compared with the most well known and thus, the most widely-used MCDA method – i.e. the Analytic Hierarchy Process (AHP) administered using Expert Choice software. AHP is considered as a benchmark among the MCDA methods by many MCDA practitioners. Both AHP and PAPRIKA are two prominent MCDA methods that have been used in many different fields and appeared in many publications. It is worthwhile to compare the two methods based on their theoretical foundations. Along with AHP and PAPRIKA, their associated decision-making software – i.e. Expert Choice and 1000minds – are considered in the evaluation framework. The findings indicate that AHP (and Expert Choice) and PAPRIKA (and 1000minds) use different theoretical foundations at different stages of the decision-making process from eliciting participants’ preferences to calculating the criteria weights and alternatives scores. As such, PAPRIKA uses choice-based pairwise comparison questions, whereas AHP uses ratio scale-based paired comparison questions to elicit participants’ preferences. AHP, unlike PAPRIKA, does not enforce the transitivity property. In Chapter 5, an empirical framework is established to evaluate the performance of AHP (and Expert Choice) and PAPRIKA (and 1000minds) based on the NCD survey (the main subject of this thesis), as well as a second survey about smartphones. In the framework, a holdout choice task is employed for investigating the performance of AHP (and Expert Choice) and PAPRIKA (and 1000minds) to predict participants’ actual choices. The findings reveal that PAPRIKA (and 1000minds) is more likely to outperform AHP (and Expert Choice) based on both decision case studies about NCDs and smartphones. PAPRIKA could produce repeatable results over time and show higher validity to predict participants’ actual choices. Given the diversity of MCDA methods and in the absence of a gold standard, evaluating the chosen MCDA method(s) based on their theoretical foundations may not be sufficient. An appropriate MCDA method is also required to produce robust results. Ideally, the theoretical and empirical frameworks developed in Chapters 4 and 5 could help MCDA practitioners consider a holistic approach to justify the choice of MCDA – which is the primary purpose of ‘step 7’ in the MCDA process – and choose a method that is developed on sound theoretical foundations and that generates robust results

External validity of multi-criteria preference data obtained from non-random sampling: measuring cohesiveness within and between groups

An important component of multi-criteria decision analysis (MCDA) in the public sector is the elicitation and aggregation of preferences data collected via surveys into the relative importance of the criteria for the decision at hand. These aggregated preferences data, usually in the form of mean weights on the criteria, are intended to represent the preferences of the relevant population overall. However, random sampling is often not feasible for public-sector MCDA for logistical reasons, including the expense involved in identifying and recruiting participants. Instead, non-random sampling methods such as convenience, purposive or snowball sampling are widely used. Nonetheless, provided the preferences data collected are sufficiently ‘cohesive’ in terms of the extent to which the weights of the individuals belonging to the various exogenously defined groups in the sample are similar, non-random sampling can still produce externally valid aggregate preferences data. We explain a method for measuring cohesiveness using the Kemeny and Hellinger distance measures, which involve measuring the ‘distance’ of participants’ weights (and the corresponding rankings of the criteria) from each other, within and between the groups respectively. As an illustration, these distance measures are applied to data from a MCDA to rank non-communicable diseases according to their overall burden to society. We conclude that the method is useful for evaluating the external validity of preferences data obtained from non-random sampling

Scoping literature review of evidence on cost and effectiveness outcomes of non-medical prescribing by health professionals

Protocol for a scoping literature review study to identify and map the evidence on cost and effectiveness outcomes of non-medical prescribing by health professional

Costs of HIV/AIDS: a case study in Iran

Advanced HIV (AIDS) is a phenomenon that its social, cultural and economic aspects are very broad and it can be regarded as an important obstacle in human progress. Considering the possibility of the future expansion, especially in developing countries with limited resources, thinking about its economic aspect is inevitable. The aim of this study was to calculate advanced and non-advanced HIV infection costs to patients in the selected referral centers in Iran. This is the kind of descriptive and cross-sectional study that was carried out on 120 out of 400 patients in the selected referral centers in Iran (the largest referral canters providing services to patients with advanced and non- advanced HIV) in four groups including advanced HIV with addiction, advanced HIV without addiction, non- advanced HIV with addiction and non advanced HIV without addiction in 2010. The study involves collecting data from available resources (including patient files and referral to the relevant centers) and interviews with patients and according to a valid questionnaire. The average annual total cost in groups first to forth were $18,583.44,$16,135.16, $7,029.48 and$7,007.44 respectively (P<0.01). Also the average of direct and indirect costs was significant (P<0.01). Considering the high costs of the disease and the low average age and education level in the study, using the evidence based educational intervention in order to increase the level of awareness to prevent further spread of the disease especially among the younger generation can lead to reduce the expenditure

Costs, consequences and value for money in non-medical prescribing: a scoping review

Objectives Non-medical prescribing (NMP) is a key feature of the UK healthcare system that refers to the legal prescribing rights granted to nurses, pharmacists and other non-medical healthcare professionals who have completed an approved training programme. NMP is deemed to facilitate better patient care and timely access to medicine. The aim of this scoping review is to identify, synthesise and report the evidence on the costs, consequences and value for money of NMP provided by non-medical healthcare professionals. Design: Scoping review Data sources: MEDLINE, Cochrane Library, Scopus, PubMed, ISI Web of Science and Google Scholarwere systematically searched from 1999 to 2021. Eligibility criteria: Peer-reviewed and grey literature written in English were included. The research was limited to original studies evaluating economic values only or both consequences and costs of NMP. Data extraction and synthesis: The identified studies were screened independently by two reviewers for final inclusion. The results were reported in tabular form and descriptively. Results: A total of 420 records were identified. Of these, nine studies evaluating and comparing NMP with patient group discussions, GP-led usual care, or services provided by non-prescribing colleagues were included. All studies evaluated the costs and economic values of prescribing services by nonmedical prescribers, and eight assessed patient, health or clinical outcomes. Three studies showed pharmacist prescribing was superior in all outcomes and cost-saving at large scale. Others reported similar results in most health and patient outcomes across other non-medical prescribers and control groups. NMP was deemed resource-intensive to both providers and other groups of non-medical prescribers (e.g. nurses, physiotherapists, podiatrists). Conclusions: The review demonstrated the need for quality evidence from more rigorous methodological studies examining all relevant costs and consequences to show value for money in NMP and inform the commissioning of NMP for different groups of healthcare professionals

Medicines management activity of advanced practice dietitians and therapeutic radiographers: a rapid review

No description supplied</p

Activity based costing in health care center: a case study of Iran

Lack of attention to real costs has made implementing a costing system which targets the listed purposes in the appropriate format pilot units seem essential. The purpose of this study is to calculate the unit cost of services provided in a health care center in Iran. This study has a cross sectional description and is based on the 2010 financial data. The department studied is a health center affiliated to Tehran University of Medical Sciences. A scientific committee which is composed of the health and budget and financing experts was set up. Then the required form was designed to collect data on the costs and services provided. Data entry was done through Excel software and analyzed based on activity based costing system following eight steps. The results of this study are presented as a “unit cost” of more than 80 types of services offered in the final activity units of the health center studied. Polio vaccine by the unit of vaccination with the unit cost of $0.84 and TB treatment by disease unit with the unit cost of$64.79 are respectively the lowest and highest unit costs of services rendered by the health center studied. Due to the high share of personnel costs of total expenditures (73%), increased labor productivity plays an important role in reducing costs. Moreover, integrated units with similar services, according to their capacity to accept and organize similar activities in the implementation process of various services to prevent their repetition, are also effective in reducing costs

Costs and consequences of services provided by non-medical prescribers: a scoping review protocol

Non-medical prescribing (NMP) is deemed to facilitate better patient care and timely access to medicine. This scoping review protocol is designed to explore and synthesise the evidence on costs and consequences of NMP services provided by non-medical healthcare professionals. This protocol is prepared based on the framework recommended by Arksey and O'Malley and further refined by Levac et al and the Joanna Briggs Institute. MEDLINE, the Cochrane Library, Science Direct, Scopus, PubMed, ISI Web of Science and Google Scholar will be systematically searched. The search strategy will include both peer-reviewed and grey literature written in English from 1999 to 2021. The identified studies will be screened independently by two reviewers for final inclusion. The results will be reported in graphical form and descriptively. The findings of this scoping review will provide valuable insights for researchers and policy-makers to inform policy and practice around NMP