DEVELOPMENT OF THE ONTARIO DECISION FRAMEWORK: A VALUES BASED FRAMEWORK FOR HEALTH TECHNOLOGY ASSESSMENT. (10th July 2018)

• Record Type: Journal Article
• Authors: Krahn, Murray; Miller, Fiona; Bayoumi, Ahmed; Brooker, Ann-Sylvia; Wagner, Frank; Winsor, Shawn; Giacomini, Mita; Goeree, Ron; Schünemann, Holger; van der Velde, Gabrielle; Petersen, Stephen; Sikich, Nancy; Dhalla, Irfan
• Is Part Of: International journal of technology assessment in health care. Volume 34:Number 3(2018)
• Page Start: 290
• Page End: 299
• Publication Date: 2018-07-10
• Subjects: Decision framework, -- Values, -- Health technology, -- Health technology assessment, -- Multi-criteria decision making; Medical technology -- Periodicals; Technology assessment -- Periodicals; 610.28
• DOI: 10.1017/S0266462318000235
• Languages: English
• ISSNs: 0266-4623

Abstract

Abstract : Objectives: In 2007, the Ontario Health Technology Advisory Committee (OHTAC) developed a decision framework to guide decision making around nondrug health technologies. In 2012, OHTAC commissioned a revision of this framework to enhance its usability and deepen its conceptual and theoretical foundations. Methods: The committee overseeing this work used several methods: (a) a priori consensus on guiding principles, (b) a scoping review of decision attributes and processes used globally in health technology assessment (HTA), (c) presentations by methods experts and members of review committees, and (d) committee deliberations over a period of 3 years. Results: The committee adopted a multi-criteria decision-making approach, but rejected the formal use of multi-criteria decision analysis. Three broad categories of attributes were identified: (I) context criteria attributes included factors such as stakeholders, adoption pressures from neighboring jurisdictions, and potential conflicts of interest; (II) primary appraisal criteria attributes included (i) benefits and harms, (ii) economics, and (iii) patient-centered care; (III) feasibility criteria attributes included budget impact and organizational feasibility. Conclusion: The revised Ontario Decision Framework is similar in some respects to frameworks used in HTA worldwide. Its distinctive characteristics are that: it is based on an explicit set of social values; HTA paradigms (evidence based medicine, economics, and bioethics/social science) are used to aggregate decision attributes; and that it is rooted in a theoretical framework of optimal decision making, rather than one related to broad social goals, such as health or welfare maximization.