GRADE EVIDENCE TO DECISION (ETD) FRAMEWORK FOR COVERAGE DECISIONS
Por:
Parmelli, E, Amato, L, Oxman, AD, Alonso-Coello, P, Brunetti, M, Moberg, J, Nonino, F, Pregno, S, Saitto, C, Schunemann, HJ, Davoli, M
Publicada:
1 ene 2017
Resumen:
Objectives: Coverage decisions are decisions by third party payers about whether and how much to pay for technologies or services, and under what conditions. Given their complexity, a systematic and transparent approach is needed. The DECIDE (Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence) Project, a GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group initiative funded by the European Union, has developed GRADE Evidence to Decision (EtD) framework for different types of decisions, including coverage ones.
Methods: We used an iterative approach, including brainstorming to generate ideas, consultation with stakeholders, user testing, and pilot testing of the framework.
Results: The general structure of the EtD includes formulation of the question, an assessment using twelve criteria, and conclusions. Criteria that are relevant for coverage decisions are similar to those for clinical recommendations from a population perspective. Important differences between the two include the decision-making processes, accountability, and the nature of the judgments that need to be made for some criteria. Although cost-effectiveness is a key consideration when making coverage decisions, it may not be the determining factor. Strength of recommendation is not directly linked to the type of coverage decisions, but when there are important uncertainties, it may be possible to cover an intervention for a subgroup, in the context of research, with price negotiation, or with restrictions.
Conclusions: The EtD provides a systematic and transparent approach for making coverage decisions. It helps ensure consideration of key criteria that determine whether a technology or service should be covered and that judgments are informed by the best available evidence.
Filiaciones:
Parmelli, E:
Univ Modena & Reggio Emilia, Dept Diagnost Clin & Publ Hlth Med, Italian Cochrane Ctr, Dept Epidemiol,Lazio Reg Hlth Serv,ASL Roma 1, Modena, Italy
Amato, L:
ASL Roma 1, Lazio Reg Hlth Serv, Dept Epidemiol, Rome, Italy
Oxman, AD:
Norwegian Inst Publ Hlth, Ctr Informed Hlth Choices, Oslo, Norway
Alonso-Coello, P:
IIB St Pau CIBERESP, Iberoamer Cochrane Ctr, Barcelona, Spain
McMaster Univ, Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
McMaster Univ, Med, Hamilton, ON, Canada
Brunetti, M:
Local Hlth Author, Modena, Italy
Moberg, J:
Norwegian Knowledge Ctr Hlth Serv, Global Hlth Unit, Oslo, Norway
Nonino, F:
Drug & Devices Evaluat Area, Bologna, Emilia Romagna, Italy
Pregno, S:
Local Hlth Author, Modena, Italy
Saitto, C:
Local Hlth Author ASL Roma 1, Rome, Italy
Schunemann, HJ:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
McMaster Univ, Dept Med, Hamilton, ON, Canada
Davoli, M:
ASL Roma 1, Lazio Reg Hlth Serv, Dept Epidemiol, Rome, Italy
Green Accepted, Hybrid Gold
|