EVIDENCE, VALUES, AND DECISION MAKING

2014 ◽  
Vol 30 (2) ◽  
pp. 233-238 ◽  
Author(s):  
Michael D. Rawlins
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Observational Study ◽  
Social Values ◽  
Clinical Excellence ◽  
Health Technology ◽  
Evidence Base ◽  
Social Value ◽  
Value Judgments ◽  
Study Designs

Background: The evidence supporting the use of new, or established, interventions may be derived from either (or both) experimental or observational study designs. Although a rigorous examination of the evidence base for clinical and cost-effectiveness is essential, it is never sufficient, and those undertaking a health technology assessment (HTA) also have to exercise judgments.Methods: The basis for this discussion is largely from the author's experience as chairman of the national Institute for Health and Clinical Excellence (NICE).Results: The judgments necessary for HTA to make are twofold. Scientific judgments relate to the interpretation of the science. Social value judgments are concerned with the ethical principles, preferences, culture, and aspirations of society.Conclusions: How scientific and social value judgments might be most appropriately captured is a challenge for all HTA agencies. Although competent HTA bodies should be able to exercise scientific judgments they have no legitimacy to impose their own social values. These must ultimately be informed by the general public.

scholarly journals REVEALING AND ACKNOWLEDGING VALUE JUDGMENTS IN HEALTH TECHNOLOGY ASSESSMENT

2014 ◽  
Vol 30 (6) ◽  
pp. 579-586 ◽  
Author(s):  
Bjørn Hofmann ◽  
Irina Cleemput ◽  
Kenneth Bond ◽  
Tanja Krones ◽  
Sigrid Droste ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Social Issues ◽  
Health Technology ◽  
Social Value ◽  
Decision Making Process ◽  
Value Judgments ◽  
Health Technologies ◽  
Scientific Endeavor

Background:Although value issues are increasingly addressed in health technology assessment (HTA) reports, HTA is still seen as a scientific endeavor and sometimes contrasted with value judgments, which are considered arbitrary and unscientific. This article aims at illustrating how numerous value judgments are at play in the HTA process, and why it is important to acknowledge and address value judgments.Methods:A panel of experts involved in HTA, including ethicists, scrutinized the HTA process with regard to implicit value judgments. It was analyzed whether these value judgments undermine the accountability of HTA results. The final results were obtained after several rounds of deliberation.Results:Value judgments are identified before the assessment when identifying and selecting health technologies to assess, and as part of assessment. They are at play in the processes of deciding on how to select, frame, present, summarize or synthesize information in systematic reviews. Also, in economic analysis, value judgments are ubiquitous. Addressing the ethical, legal, and social issues of a given health technology involves moral, legal, and social value judgments by definition. So do the appraisal and the decision-making process.Conclusions:HTA by and large is a process of value judgments. However, the preponderance of value judgments does not render HTA biased or flawed. On the contrary they are basic elements of the HTA process. Acknowledging and explicitly addressing value judgments may improve the accountability of HTA.

scholarly journals Health technology assessment in the United Kingdom

2009 ◽  
Vol 25 (S1) ◽  
pp. 178-181 ◽  
Author(s):  
Michael Drummond ◽  
David Banta
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Cost Effectiveness ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Clinical Excellence ◽  
Present Situation ◽  
Health Technology ◽  
The United Kingdom ◽  
Short Run

Objectives: The aim of this study was to describe generally the development and present situation with health technology assessment (HTA) in the United Kingdom.Methods: The methods used are a review of important materials that have described the development process and present situation, supplemented by some personal experiences.Results: The United Kingdom has been characterized historically as a country with a strong interest in evidence in health care, both clinical trials for efficacy and cost-effectiveness analyses. However, this evidence was not well-linked to the needs of the National Health Services (NHS) before formation of the NHS R&D Programme in 1991, The R&D Programme brought substantial resources into HTA and related activities, with the central aim of improving health care in Britain and increasing value for money. However, policy makers as well as staff of the R&D Programme were dissatisfied with the use of the HTA results in clinical and administrative practice. Therefore, the National Institute of Clinical Excellence (NICE) was formed in 1999. NICE issues guidance intended to influence practical decision making in health care at the national and local levels, based on efficacy information and, in some cases, economic analyses. NICE is now also seeking ways to maximize impacts on practice.Conclusions: The UK experience shows that information on clinical and cost-effectiveness may not be enough to change practice, at least in the short-run. Still, one may conclude that the United Kingdom now has one of the few most important and influential HTA programs in the world.

scholarly journals Patient advocacy group involvement in health technology assessments: an observational study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Ann Single ◽  
Ariana Cabrera ◽  
Simon Fifer ◽  
Jane Tsai ◽  
Jin-Young Paik ◽  
...  
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Patient Involvement ◽  
Patient Advocacy ◽  
Health Technology ◽  
Access To Medicines ◽  
Evidence Base ◽  
Lack Of Information ◽  
Local Setting ◽  
Patient Advocacy Group

Abstract Background In some jurisdictions, patients and patient groups may be invited to provide input when Health Technology Assessment (HTA) is used to inform decisions about which medicines should be subsidised or funded. This input can help frame the evidence from a patient perspective, address uncertainties in the evidence and interpret it for the local setting. However, there is currently no evidence linking patient involvement with positive reimbursement decisions. Aim We aimed to understand the expectations of patient involvement in the reimbursement process, especially among cancer patient advocacy groups (PAGs) in New Zealand (Aotearoa), South Korea and Taiwan. Methods We developed an online survey to help understand the role that cancer PAGs play in reimbursement processes and identify knowledge gaps about the processes that might impact the efforts of PAGs. The survey elicited the views of staff and patients affiliated with PAGs (n = 43) on current practices and how the assessment and reimbursement of new cancer drugs might be improved. Results There was variability in knowledge of the HTA assessment processes and in experience of being involved in them. Those with HTA experience were more likely to have confidence in the process. Those who had not been involved tended to have little awareness of, or frustration with, decision-making processes. Most identified cost, finances and economic assessments as key considerations in current processes. Some respondents had clear ideas about how their knowledge and involvement could improve processes to determine the value of new medicines. However, for many, a lack of information about the basis for decision making and opportunities to be involved was a barrier to identifying process improvement. Conclusions HTA is implemented primarily in countries seeking to have fair and equitable processes for funding medicines. PAGs often recognise the financial challenges of funding new medicines and share the desire for procedural fairness. The connection PAGs make between patient involvement and improved access to new medicines may be based on the belief they can add information to the evidence base, help solve problems, ensure fairness through transparency and/or influence the culture towards increased access to medicines they value.

scholarly journals Challenges in synthesising cost-effectiveness estimates

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Gemma E. Shields ◽  
Jamie Elvidge
Keyword(s):  
Cost Effectiveness ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cost Effective ◽  
Evidence Base ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Study Designs

AbstractEconomic evaluations help decision-makers faced with tough decisions on how to allocate resources. Systematic reviews of economic evaluations are useful as they allow readers to assess whether interventions have been demonstrated to be cost effective, the uncertainty in the evidence base, and key limitations or gaps in the evidence base. The synthesis of systematic reviews of economic evaluations commonly takes a narrative approach whereas a meta-analysis is common step for reviews of clinical evidence (e.g. effectiveness or adverse event outcomes). As they are common objectives in other reviews, readers may query why a synthesis has not been attempted for economic outcomes. However, a meta-analysis of incremental cost-effectiveness ratios, costs, or health benefits (including quality-adjusted life years) is fraught with issues largely due to heterogeneity across study designs and methods and further practical challenges. Therefore, meta-analysis is rarely feasible or robust. This commentary outlines these issues, supported by examples from the literature, to support researchers and reviewers considering systematic review of economic evidence.

scholarly journals SCIENTIFIC AND SOCIAL VALUE JUDGMENTS FOR ORPHAN DRUGS IN HEALTH TECHNOLOGY ASSESSMENT

2016 ◽  
Vol 32 (4) ◽  
pp. 218-232 ◽  
Author(s):  
Elena Nicod ◽  
Panos Kanavos
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Orphan Drugs ◽  
Social Value ◽  
European Medicines Agency ◽  
Final Decision ◽  
Value Judgments ◽  
Accountability For Reasonableness ◽  
The Impact

Objectives: We explore how broader aspects of a treatment's value and the impact of the condition on patients not captured by routine health technology assessment (HTA) methods using clinical and economic evidence, defined as “other considerations,” may influence HTA processes in different settings.Methods: Countries included were England, Scotland, Sweden, and France. Data sources were the publicly available reports on HTA recommendations. Ten drugs with European Medicines Agency orphan designation and appraised in England were selected. Qualitative thematic analysis was used to systematically identify and code all “other considerations” based on a previously developed methodological framework, which also coded whether it was provided by stakeholders, and how it influenced the decision.Results: A classification framework of scientific and social value judgments was developed and used throughout the study. A total of 125 “other considerations” were identified and grouped into ten subcategories based on the information provided. Eighteen to 100 percent of these, depending on the agency, were put forward as one of the main reasons for the final decision potentially contributing to accepting a higher incremental cost-effectiveness ratio or uncertain evidence. Some of these were nonquantified or nonelicited and pertained to the assessor's judgment. A taxonomy of these value judgments was created to be used in future cases. Results also contributed to better defining the determinants of social value and improving accountability for reasonableness.Conclusions: The systematic identification of the scientific and social value judgments enables to better understanding the dimensions of value, which can be used to improve their transparency and consistent use across decisions and settings.

scholarly journals Health technology assessment and mental health

2002 ◽  
Vol 26 (7) ◽  
pp. 243-245 ◽  
Author(s):  
Angus Mackay
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Clinical Excellence ◽  
Health Technology ◽  
Health Intervention ◽  
Health Improvement ◽  
Scottish Intercollegiate Guideline Network ◽  
Health Technologies ◽  
Clinical Procedures ◽  
Crude Approximation

In company with all other branches of the NHS, those concerned with mental health are currently the target of a plethora of standards, guidelines and derivatives thereof. In England and Wales, the responsibility for the production of national clinical guidelines rests with the National Institute for Clinical Excellence (NICE), and the Commission for Health Improvement (CHI) is charged with the monitoring of performance. In Scotland, the Scottish Intercollegiate Guideline Network (SIGN) and the Clinical Standards Board for Scotland (CSBS) undertake these respective responsibilities. However, NICE is also responsible for a rather different form of activity, and one that has forced it recurringly into the media limelight in the 2 years since its creation. This is the formulation of national advice on the clinical and cost-effectiveness of new and existing health technology. Health technology is a rather pedantic, if precisely defined, term that means essentially any health intervention and it includes medicines, devices, clinical procedures and even health care settings. Post-devolution and in the wake of the establishment of the Scottish Parliament, the Health Technology Board for Scotland (HTBS) was created by statute in April 2000. This organisation shares with NICE the responsibility for issuing advice on the clinical and cost-effectiveness of health technologies, in HTBS's case primarily to NHS Scotland. Therefore, two nationally-oriented organisations exist on either side of Hadrian's Wall, responsible to their respective Parliaments for providing authoritative opinions on whether or not a particular health intervention should be provided within the NHS. A crude approximation to the subject of this advice would be ‘value for money’. While, for reasons that will be explained, such a term is potentially misleading, it does serve to identify the basic elements of the need to which this activity is a response.

scholarly journals Values and inductive risk in machine learning modelling: the case of binary classification models

2021 ◽  
Vol 11 (4) ◽  
Author(s):  
Koray Karaca
Keyword(s):  
Machine Learning ◽  
Social Values ◽  
Binary Classification ◽  
Social Value ◽  
Classification Models ◽  
Value Judgments ◽  
Philosophical Debate ◽  
Inductive Risk ◽  
The Social ◽  
Error Costs

AbstractI examine the construction and evaluation of machine learning (ML) binary classification models. These models are increasingly used for societal applications such as classifying patients into two categories according to the presence or absence of a certain disease like cancer and heart disease. I argue that the construction of ML (binary) classification models involves an optimisation process aiming at the minimization of the inductive risk associated with the intended uses of these models. I also argue that the construction of these models is underdetermined by the available data, and that this makes it necessary for ML modellers to make social value judgments in determining the error costs (associated with misclassifications) used in ML optimization. I thus suggest that the assessment of the inductive risk with respect to the social values of the intended users is an integral part of the construction and evaluation of ML classification models. I also discuss the implications of this conclusion for the philosophical debate concerning inductive risk.

scholarly journals Mapping the social values of ecosystem services to support better decision making

2021 ◽  
Author(s):  
Sedigheh Mousavipour
Keyword(s):  
Decision Making ◽  
Social Media ◽  
Ecosystem Services ◽  
Cultural Values ◽  
Online Survey ◽  
Social Values ◽  
Well Being ◽  
Social Value ◽  
General View ◽  
Landscape Units

<p><b>Social values of ecosystem services are the perceived benefits of natural ecosystems for the well-being of people. For sustainable land management, social values and preferences need to be integrated into land-use decision-making. Existing methods of social value capture commonly use participatory mapping and deliberative mapping. However, social media data has recently contributed to the gathering of spatial social value data. By reducing the time and cost of mapping, social media may be effective in social value mapping. However, the credibility of this data source has rarely been assessed for land planning.</b></p> <p>This thesis critically analysed the results of social media-based mapping (passive Volunteered Geographic Information (VGI)) and deliberative mapping (expert-based evaluation) methods into providing credible social value data (recreation, aesthetics, and historical/cultural values) for recreation planning. We analysed the content of 4642 photographs uploaded to Flickr as passive VGI and the results of an online survey and face to face interview for expert-based evaluation. This thesis found both the passive VGI and expert-based evaluation could identify all three types of relevant social values for ecosystem services (recreation, aesthetics, and historical/cultural). </p> <p>Passive VGI can provide reasonably reliable information on the recreational preferences of people at the time that data is provided. Although social values identified in expert-based evaluation included useful information about current public preferences and a potential supply of recreation ecosystem services, it only captured a general view of the study area. Large areas of interest were provided by each of the experts participating in the online survey. Several landscape units were missed by passive VGI while expert-based dataset overrepresented a majority of landscape units. </p> <p>The results of this research demonstrated that spatial social value data are limited when a single method is applied. Potential users of such data need to understand their limitations. Applying several mapping methods (PPGIS, expert-based evaluation, passive VGI, etc.) may create a more useful and credible social value dataset to appropriately support recreational planning.</p>

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