Online Resource 3: Classification of Healthcare Funding Decision Criteria
Guindo et.al.[a]aimed to identify the decision criteria (and their frequency) considered by public funding decision-makerswhen evaluating healthcare interventions, based on evaluation of the healthcare decision-making literature. Decision criteria were extracted and organized using a classification system base on the EVIDEM framework,[b] from studies of several world regions and involving decision-makingat the micro, meso and macro levels. Frequency of mention (counts) were measured based on frequency of occurrence in the literature. Guindo identified 360 different terms used in public funding decision-making, which were assigned to 58 criteria and classified into 9 categories, shown in the table below.
Our focus is on the criteria considered by public payers making funding decisions for new high-cost cancer drugs. After searching the literature for classification schemes, we found Guindo’s classification was the most recent and comprehensive fit for our pusposes. Our study examines the criteria considered by public payers for only a subset of Guindo’s criteria:
(i) we are considering only the funding criteria, and not the process.
(ii) we are considering only the ‘macro level’ (funding decision-maker), and not considering the factors considered at the meso level (healthcare facility) or micro level (healthcare provider).
Therefore, several of Guindo’s criteria do not apply to our study, and are shaded: C3, D4, E4, F5, G1-4, G6, G8, H5, I1, I2, I4, I6, I7, I9, I10.
Categories of classification system / Coding / Funding CriteriaA-Health outcomes and benefits of intervention / A1 / Health benefits
A2 / Efficacy/effectiveness
A3 / Life saving
A4 / Safety
A5 / PRO
B-Type of health benefit / B1 / Population Effect
B2 / Individual effect
C-Impact of the disease targeted by intervention / C1 / Disease Severity
C2 / Disease Determinants
C3 / Disease Burden
C4 / Epidemiology
D-Therapeutic context of intervention / D1 / Treatment alternatives
D2 / Need
D3 / Practice Guidelines
D4 / Pre-existing use
E-Economic impact of intervention / E1 / Costs
E2 / Budget Impact
E3 / Broad Financial Impact
E4 / Poverty Reduction
E5 / Cost-effectiveness
E6 / Value
E7 / Efficiency & opportunity costs
E8 / Resources
E9 / Insurance Premiums
F-Evidence Quality & Uncertainty / F1 / Evidence Available
F2 / Strength of Evidence
F3 / Relevance of evidence
F4 / Evidence characteristics
F5 / Research Ethics
F6 / Evidence requirements
G- Implementation: complexity of intervention / G1 / Legislation
G2 / Organiational requirements
G3 / Skills
G4 / Flexibility of Implementation
G5 / Characteristics of intervention
G6 / Appropriate Use
G7
G8 / Integration & System efficiencies
H-Priorities fairness and ethics / H1 / Population Priorities
H2 / Access to Treatment
H3 / Vulnerable & needy population
H4 / Equity, fairness and justice
H5 / Utility
H6 / Solidarity
H7 / Ethics and moral aspects
I-Overall context / I1 / Mission and Mandate
I2 / Overall Priorities
I3 / Financial constraints
I4 / Incentives
I5 / Political Aspects
I6 / Historical Aspects
I7 / Cultural Aspects
I8 / Innovation
I9 / Partnership and leadership
I10 / Citizen involvement
I11 / Stakeholders interests and pressures
Title and Abstract screening
Included studies where:
(i)the intervention was a cancer treatment,
(ii)study subjects were cancer patients, the general public, or public payers,
(iii)study design included a predefined measure of preference, and
(iv)study outcome measures included attributes or measures of value, using domains and metrics relevant to cancer.[19][20]
and excluded if:
(i)narrative reviews,
(ii)studies with outcome measures lacking attributes or measures of value,
(iii)studies not assessing cancer drug funding preferences,
(iv)studies reporting interim/duplicate results later published.
Initial abstract screening reduced our sample to 107 studies; full-text review left 20 studies. Screening of secondary references from eligible studies yielded two additional studies, for a total of 22 studies.
[a]Guindo LA, Wagner M, Baltussen R, et.al. From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking. Cost Effectiveness and Resource Allocation; 2012;10:9
[b]Evidence and Value Impact on DEcision Making. The EVIDEM framework was designed to evaluate healthcare interventions and facilitate their prioritization using a comprehensive set of universal and contextual decision criteria organized into pragmatic tools. The framework and its tools are regularly updated by active members of the collaboration.