Why is MCDA useful? Outline

Transcription

1 Why is MCDA useful? Using MCDA for making healthcare coverage decisions in Thailand Yot Teerawattananon HITAP, Thailand s Ministry of Public Health Saw Swee Hock School of Public Health, National University of Singapore 1 Outline The challenges in using cost-effectiveness analysis to inform resource allocation Using MCDA to incorporate social values Thailand s experience in using MCDA in UHC benefit package development Lessons learned for Japan and other countries 2 1

2 Two sides of the same coin? 3 The increasing interest in using value for money for making coverage decision 4 2

3 Is a QALY a QALY? 5 If only one organ available for transplantation and you have to manage it. You will A: Give to 20 year- old B: Give to 60 year- old P.6 3

4 If only one organ available for transplantation and you have to manage it. You will A: Give to 20 year- old who are drug addicted and murder B: Give to 60 year- old who are a university professor P.7 If only one organ available for transplantation and you have to manage it. You will A: Give to 20 year-old with no dependence B: Give to 30 year-old female with a baby P.8 4

5 If only one organ available for transplantation and you have to manage it. You will A: Give to 30 year- very rich B: Give to 30 year- very poor P.9 Social value in health policy Population characteristics e.g. age, gender, education, social status etc. Disease severity Equity Others.. P.10 5

6 MCDA is an aid to decision making which makes the impact of multiple criteria on decisions more explicit, and the relative importance attached to them P.11 This slide is adapted from the presentations Prof. Rob Baltussen UHC benefit package development Participatory-Transparent-Evidence-based-Contestable 7 groups of stakeholders Stakeholders Working Group Researchers Committee for Benefit Package Development Nomination of interventions Prioritization Assessments Appraisals Cost-effectiveness Budget impact MCDA criteria: a) Magnitude & severity of problems b) Effectiveness of interventions c) Variation in practice d) Financial impact on households e) Equity & ethical dimension problem of the marginalized rare diseases Appeals by stakeholders NHSO Board Decisions Youngkong S, Baltussen R, Tantivess S, Mohara A, Teerawattananon Y. Multicriteria decision analysis for including health interventions in the universal health coverage benefit package in Thailand. Value Health. 2012;15(6): Mohara A, Youngkong S, Pérez Velasco R, Werayingyong P, Pachanee K, Prakongsai P, Tantivess S, Tangcharoensathien V, Lertiendumrong J, Jongudomsuk P, TeerawattananonY. Using health technology assessment for informing coverage decisions in Thailand. J Compar Effect Res 2012;1(2):

7 Prioritization Topics for conducting HTA studies 13 Using economic evaluation for UHC benefit package development Health Interventions Comparators Baht/QALY (2009) Coverage decisions AZT+3TC+LPV/r for PMTCT AZT plus single dose NVP cost-saving Yes Dental implant conventional complete denture 51,000 No Provider-initiated HIV testing Voluntary HIV counseling-testing 70,000 Yes Bone marrow transplantation for thalassemia Blood transfusion 120,000 Yes HLA-B*1502 in neuropathic pain patient No screening 120,000 Yes HLA-B*1502 in patients with epilepsy No screening 200,000 Yes HPV vaccine for girls aged 15 years Pap smear q 5 years aged ,000 No Alendronate or Residronate for osteoporosis calcium + vitamin D 2-400,000 No Cochlear implantation for profoundly deaf training hand language 400,000 No Fordable lens for cataract Rigid intraoccular lens 507,000 No Atorvastatin in pop >30% CVD risk exercise & diet control 600,000 No Peritoneal dialysis for ESRD palliative care 435,000 Yes Hemodialysis for ESRD palliative care 449,000 Yes Erythropoitin for anemia in cancer blood transfusion 2,700,000 No 14 7

8 Lessons learned MCDA can improve Quality of decisions by addressing all relevant criteria Transparency of decisions by being explicit Consistency of decisions by using same principles over time -> Legitimacy of decisions MCDA is not only about the technical content but also process e.g. participatory, transparency, timeliness etc. Country jurisdiction needs to find locally relevant MCDA approach e.g. MCDA can be applied in many steps of policy process Making policy is difficult and there is more to policy than evidence

9 Criteria used in selection of topics A consultation panel among policy makers and academics Establishing the definition and measurement Scoring system by six criteria Ordinal scale from 1 to 5 Equal weight

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