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Review
. 2020 Feb 11:18:8.
doi: 10.1186/s12962-020-0203-6. eCollection 2020.

Development of the WHO-INTEGRATE evidence-to-decision framework: an overview of systematic reviews of decision criteria for health decision-making

J M Stratil  1 , R Baltussen  2 , I Scheel  3 , A Nacken  1 , E A Rehfuess  1
Affiliations
Review

Development of the WHO-INTEGRATE evidence-to-decision framework: an overview of systematic reviews of decision criteria for health decision-making

J M Stratil et al. Cost Eff Resour Alloc. .

Abstract

Background: Decision-making in public health and health policy is complex and requires careful deliberation of many and sometimes conflicting normative and technical criteria. Several approaches and tools, such as multi-criteria decision analysis, health technology assessments and evidence-to-decision (EtD) frameworks, have been proposed to guide decision-makers in selecting the criteria most relevant and appropriate for a transparent decision-making process. This study forms part of the development of the WHO-INTEGRATE EtD framework, a framework rooted in global health norms and values as reflected in key documents of the World Health Organization and the United Nations system. The objective of this study was to provide a comprehensive overview of criteria used in or proposed for real-world decision-making processes, including guideline development, health technology assessment, resource allocation and others.

Methods: We conducted an overview of systematic reviews through a combination of systematic literature searches and extensive reference searches. Systematic reviews reporting criteria used for real-world health decision-making by governmental or non-governmental organization on a supranational, national, or programme level were included and their quality assessed through a bespoke critical appraisal tool. The criteria reported in the reviews were extracted, de-duplicated and sorted into first-level (i.e. criteria), second-level (i.e. sub-criteria) and third-level (i.e. decision aspects) categories. First-level categories were developed a priori using a normative approach; second- and third-level categories were developed inductively.

Results: We included 36 systematic reviews providing criteria, of which one met all and another eleven met at least five of the items of our critical appraisal tool. The criteria were subsumed into 8 criteria, 45 sub-criteria and 200 decision aspects. The first-level of the category system comprised the following seven substantive criteria: "Health-related balance of benefits and harms"; "Human and individual rights"; "Acceptability considerations"; "Societal considerations"; "Considerations of equity, equality and fairness"; "Cost and financial considerations"; and "Feasibility and health system considerations". In addition, we identified an eight criterion "Evidence".

Conclusion: This overview of systematic reviews provides a comprehensive overview of criteria used or suggested for real-world health decision-making. It also discusses key challenges in the selection of the most appropriate criteria and in seeking to implement a fair decision-making process.

Keywords: Criteria; Decision-making; Decisionmaking; HTA; Health technology assessment; Priority-setting; Resource allocation; WHO; WHO-INTEGRATE.

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Conflict of interest statement

Competing interestsThis research was conducted within a research project initiated by the World Health Organization in which the WHO-INTEGRATE EtD Framework V1.0 was first developed and published by the authors. The authors declare that they have no competing interests. The funding organizations, in particular the USAID, the Bavarian Health and Food Safety Authority and Norad had no influence on the research process or content of this manuscript.

References

    1. Sanderson I. Intelligent policy making for a complex world: pragmatism, evidence and learning. Polit Stud. 2009;57(4):699–719. doi: 10.1111/j.1467-9248.2009.00791.x. - DOI
    1. Rajan D, Adam T, El Husseiny D, Porignon D, Ghaffar A, Schmets G. Briefing Note—Policy dialogue: what it is and how it can contribute to evidence-informed decision-making. Geneva: World Health Organization; 2015.
    1. Holm S. The second phase of priority setting. Goodbye to the simple solutions: the second phase of priority setting in health care. BMJ. 1998;317:1000–1002. doi: 10.1136/bmj.317.7164.1000. - DOI - PubMed
    1. Burchett H, Mounier-Jack S, Griffiths U, Mills A. National decision-making on adopting new vaccines: a systematic review. Health Policy Plan. 2012;27(SUPPL.2):ii62–ii76. - PubMed
    1. Cromwell I, Peacock SJ, Mitton C. ‘Real-world’ health care priority setting using explicit decision criteria: a systematic review of the literature. BMC Health Serv Res. 2015;15:164. doi: 10.1186/s12913-015-0814-3. - DOI - PMC - PubMed

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