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Field testing of a multicriteria decision analysis (MCDA) framework for coverage of a screening test for cervical cancer in South Africa.doc

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Field testing of a multicriteria decision analysis (MCDA) framework for coverage of a screening test for cervical cancer in South Africa

Miotetal.CostEffectivenessandResourceAllocation2012,10:2 /content/10/1/2 RESEARCH OpenAccess Fieldtestingofamulticriteriadecisionanalysis (MCDA)frameworkforcoverageofascreening testforcervicalcancerinSouthAfrica JacquiMiot1*,MonikaWagner2,HananeKhoury2,DonnaRindress2andMireilleMGoetghebeur2 Abstract Background:Systematicandtransparentapproachestoprioritysettingareneeded,particularlyinlow-resource settings,toproducedecisionsthataresoundandacceptabletostakeholders.TheEVIDEMframeworkbrings togetherHealthTechnologyAssessment(HTA)andmulti-criteriadecisionanalysis(MCDA)byproposinga comprehensivesetofdecisioncriteriatogetherwithstandardizedprocessestosupportdecisionmaking.The objectiveofthestudywastofieldtesttheframeworkfordecisionmakingonascreeningtestbyaprivatehealth planinSouthAfrica. Methods:Liquid-basedcytology(LBC)forcervicalcancerscreeningwasselectedbythehealthplanforthisfield test.AnHTAreportstructuredbydecisioncriterion(14criteriaorganizedintheMCDAmatrixand4contextual criteria)wasproducedbasedonaliteraturereviewandinputfromthehealthplan.Duringworkshopsessions, committeemembers1)weightedeachMCDAdecisioncriteriontoexpresstheirindividualperspectives,and2)to appraiseLBC,assignedscorestoeachMCDAcriteriononthebasisoftheby-criterionHTAreport. CommitteemembersthenconsideredthepotentialimpactsoffourcontextualcriteriaontheuseofLBCinthe contextoftheirhealthplan.Feedbackontheframeworkandprocesswascollectedthroughdiscussionandfroma questionnaire. Results:For9oftheMCDAmatrixdecisioncriteria,89%ormoreofcommitteemembersthoughttheyshould alwaysbeconsideredindecisionmaking.Greatestweightsweregiventothecriteria“Budgetimpact”,“Cost- effectiveness”and“Completenessandconsistencyofreportingevidence”.WhenappraisingLBCforcervicalcancer screening,thecommitteeassignedthehighestscoresto“Relevanceandvalidityofevidence”and“Disease severity”.CombinationofweightsandscoresyieldedameanMCDAvalueestimateof46%(SD7%)ofthe potentialmaximumvalue.Overall,thecommitteefelttheframeworkbroughtgreaterclarityt