• Management
• cost
• management
• medical education research

• clinical program prioritization
• decision-making frameworks
• evidence-based frameworks
• financial constraints
• health technology assessment
• healthcare 4.0 technologies
• healthcare sustainability
• hospital investment
• predictive analytics
• resource allocation

• democracy
• health care governance
• knowledge broker
• politics
• resource allocation

• Politics
• Leadership
• Sweden
• Health Priorities
• Humans
• Delivery of Health Care/organization & administration
• Advisory Committees/organization & administration

• Humans
• Cost-Benefit Analysis
• Delivery of Health Care
• Budgets
• COVID-19
• Health Care Rationing

• NIHR Oxford Biomedical Research Centre
• National Institute for Health and Care Research Applied Research Collaboration Oxford and Thames Valley
• NIHR Oxford Health BRC

• Health policy
• Priority setting
• Severity
• Thematic analysis
• Views of the public

• Adult
• Humans
• Concept Formation
• Delivery of Health Care
• Health Facilities
• Norway
• Netherlands

• University of Oslo (incl Oslo University Hospital)

• COVID-19 national plans
• Priority setting
• Stakeholder participation

• Humans
• Stakeholder Participation
• Pandemics
• Pandemic Preparedness
• COVID-19
• Delivery of Health Care

• Child
• Humans
• Male
• Female
• Anxiety
• Hospitals
• Pain
• Caregivers

• Decision making
• Discrete choice experiment
• Efficiency
• Germany
• Healthcare
• Innovation
• Priority setting

• Humans
• Delivery of Health Care
• Policy Making
• Health Policy
• Efficiency, Organizational
• Germany

• Friedrich-Alexander-Universität Erlangen-Nürnberg (1041)

• Decision science
• Economics
• Ethics
• Integration
• Law
• Priority setting
• Resource allocation

• Adult
• Humans
• Social Support
• Social Work
• Referral and Consultation
• Resource Allocation
• Scotland

• HIPS/16/62 Chief Scientist Office, Scottish Government Health and Social Care Directorate
• HIPS/16/62 Chief Scientist Office, Scottish Government Health and Social Care Directorate
• HIPS/16/62 Chief Scientist Office, Scottish Government Health and Social Care Directorate
• HIPS/16/62 Chief Scientist Office, Scottish Government Health and Social Care Directorate
• HIPS/16/62 Chief Scientist Office, Scottish Government Health and Social Care Directorate
• HIPS/16/62 Chief Scientist Office, Scottish Government Health and Social Care Directorate
• HIPS/16/62 Chief Scientist Office, Scottish Government Health and Social Care Directorate

• Active Disinvestment
• Low-Value Care
• Medical Overuse
• Subacromial Pain Syndrome

• Humans
• Orthopedic Surgeons
• Health Personnel
• Commerce
• Hospitals
• Pain

• Artificial intelligence
• Coronary artery disease
• Coronary heart disease
• Economic evaluation
• Health care costs

• Economics
• HTA
• Hospital
• Implementation
• MCDA
• PBMA
• Priority setting
• Resource allocation

• Humans
• Delivery of Health Care
• Resource Allocation/methods
• Hospitals

• Clinical quality improvement
• Evidence-based practices
• Healthcare providers
• Implementation science
• Prioritization

• Evidence-Informed Deliberative Processes
• Health Benefit Package
• Health Technology Assessment
• Legitimacy
• Stakeholder Involvement
• Universal Health Coverage

• Humans
• Organizations
• Stakeholder Participation
• Technology Assessment, Biomedical/methods
• Research Design
• Government

• Antenatal care
• HIV
• Health facility readiness
• Health service assessment
• Pacific
• Syphilis

• Infant, Newborn
• Female
• Pregnancy
• Humans
• Syphilis/diagnosis
• Syphilis/epidemiology
• Papua New Guinea/epidemiology
• Prenatal Care
• Ambulatory Care Facilities
• HIV Infections/diagnosis
• HIV Infections/epidemiology

In recent years, the potential of multi-criteria decision analysis (MCDA) in the health field has been discussed widely. However, most MCDA methodologies have given little attention to the aggregation of different stakeholder individual perspectives.

To illustrate how a paraconsistent theory-based MCDA reusable framework, designed to aid hospital-based Health Technology Assessment (HTA), could be used to aggregate individual expert perspectives when valuing cancer treatments.

An MCDA methodological process was adopted based on paraconsistent theory and following ISPOR recommended steps in conducting an MCDA study. A proof-of-concept exercise focusing on identifying and assessing the global value of first-line treatments for metastatic colorectal cancer (mCRC) was conducted to foster the development of the MCDA framework.

On consultation with hospital-based HTA committee members, 11 perspectives were considered in an expert panel: medical oncology, oncologic surgery, radiotherapy, palliative care, pharmacist, health economist, epidemiologist, public health expert, health media expert, pharmaceutical industry, and patient advocate. The highest weights were assigned to the criteria “overall survival” (mean 0.22), “burden of disease” (mean 0.21) and “adverse events” (mean 0.20), and the lowest weights were given to “progression-free survival” and “cost of treatment” (mean 0.18 for both). FOLFIRI and mFlox scored the highest global value score of 0.75, followed by mFOLFOX6 with a global value score of 0.71. mIFL was ranked last with a global value score of 0.62. The paraconsistent analysis (para-analysis) of 6 first-line treatments for mCRC indicated that FOLFIRI and mFlox were the appropriate options for reimbursement in the context of this study.

The Paraconsistent Value Framework is proposed as a step beyond the current MCDA practices, in order to improve means of dealing with individual expert perspectives in hospital-based HTA of cancer treatments.

This paper targets a major challenge of how to effectively allocate medical resources in intensive care units (ICUs). We trained multiple regression models using the Medical Information Mart for Intensive Care III (MIMIC III) database recorded in the period between 2001 and 2012. The training and validation dataset included pneumonia, sepsis, congestive heart failure, hypotension, chest pain, coronary artery disease, fever, respiratory failure, acute coronary syndrome, shortness of breath, seizure and transient ischemic attack, and aortic stenosis patients’ recorded data. Then we tested the models on the unseen data of patients diagnosed with coronary artery disease, congestive heart failure or acute coronary syndrome. We included the admission characteristics, clinical prescriptions, physiological measurements, and discharge characteristics of those patients. We assessed the models’ performance using mean residuals and running times as metrics. We ran multiple experiments to study the data partition’s impact on the learning phase. The total running time of our best-evaluated model is 123,450.9 mS. The best model gives an average accuracy of 98%, highlighting the location of discharge, initial diagnosis, location of admission, drug therapy, length of stay and internal transfers as the most influencing patterns to decide a patient’s readiness for discharge.

• MCDA
• multi-criteria decision analysis
• priority setting
• vaccine

• Bangladesh/epidemiology
• Cost-Benefit Analysis
• Decision Making
• Decision Support Techniques
• Delivery of Health Care
• Humans
• Vaccines/therapeutic use

Priority setting and health system governance are critical for optimising healthcare interventions and determining how best to allocate limited resources. The COVID-19 pandemic has buttressed the need for these especially now that vaccines are available to curb the spread of the disease. In many low- and middle-income countries (LMICs), vaccine coverage remains low, due in large part to sub-optimal priority setting and health system governance which has led to inequities in access and has fuelled vaccine hesitancy. An analysis of the situation in Nigeria identified key issues that have affected the health system response to COVID-19 and impeded timely access to the vaccine. These include weak vaccine procurement strategies, limited evidence on strategies for prioritising recipients and approaches for rolling out mass vaccination programmes for the entire population, lack of a communication strategy to reduce the incidence of vaccine hesitancy and failures to proactively address vaccine hesitancy through the implementation of vaccination programmes. Nigeria and other many other LMICs are still facing the prospect of subsequent and potentially worsening waves of the COVID-19 pandemic. Without effective priority setting, there is a risk that the country will not accelerate vaccine rollout quickly enough to achieve high coverage rates that will ensure herd immunity. In the context of existing weaknesses in health system governance, there is an urgent need to strengthen priority settings in Nigeria and identify and implement context-specific solutions that can improve vaccine coverage for the population.

• COVID-19/prevention & control
• COVID-19 Vaccines
• Humans
• Nigeria
• Pandemics
• Vaccination
• Vaccines

• economics
• mental health
• policy
• priority setting
• system dynamics

We examined if oncology drug indications with high clinical benefit, as measured by the American Society of Clinical Oncology Value Framework (ASCO‐VF) and European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO‐MCBS), received public reimbursement status faster than those with lower clinical benefit from the time of pan‐Canadian Oncology Drug Review (pCODR) recommendation.

Oncology drug indications submitted to pCODR between July 2011 and October 2018 were examined. Included indications had a regulatory approval date, completed the pCODR review process, received a positive pCODR recommendation, and been funded by at least one province. Trials cited for clinical efficacy were used to determine the clinical benefit (per ASCO‐VF and ESMO‐MCBS) of drug indications.

Eighty‐four indications were identified, yielding 65 ASCO‐VF and 50 ESMO‐MCBS scores. The mean ASCO‐VF and ESMO‐MCBS scores were 44.9 (SD = 21.1) and 3.3 (SD = 1.0), respectively. The mean time to provincial reimbursement from pCODR recommendation was 13.2 months (SD = 9.3 months). Higher ASCO‐VF and ESMO‐MCBS scores had low correlation with shorter time to reimbursement, (ρ = −0.21) and (ρ = 0.24), respectively. In the multivariable analyses, ASCO‐VF (p = 0.40) and ESMO‐MCBS (p = 0.31) scores were not significantly associated with time to reimbursement. Province and year of pCODR recommendation were associated with time to reimbursement in both ASCO and ESMO models.

Oncology drug indications with higher clinical benefit do not appear to be reimbursed faster than those with low clinical benefit. This suggests the need to prioritize oncology drug indications based on clinical benefit to ensure quicker access to oncology drugs with the greatest benefits.

• clinical benefit
• oncology drugs
• pCODR
• prioritization
• reimbursement

Priority setting represents an even bigger challenge during public health emergencies than routine times. This is because such emergencies compete with routine programmes for the available health resources, strain health systems and shift health-care attention and resources towards containing the spread of the epidemic and treating those that fall seriously ill. This paper is part of a larger global study, the aim of which is to evaluate the degree to which national COVID-19 preparedness and response plans incorporated priority setting concepts. It provides important insights into what and how priority decisions were made in the context of a pandemic. Specifically, with a focus on a sample of 18 African countries’ pandemic plans, the paper aims to: (1) explore the degree to which the documented priority setting processes adhere to established quality indicators of effective priority setting and (2) examine if there is a relationship between the number of quality indicators present in the pandemic plans and the country’s economic context, health system and prior experiences with disease outbreaks. All the reviewed plans contained some aspects of expected priority setting processes but none of the national plans addressed all quality parameters. Most of the parameters were mentioned by less than 10 of the 18 country plans reviewed, and several plans identified one or two aspects of fair priority setting processes. Very few plans identified equity as a criterion for priority setting. Since the parameters are relevant to the quality of priority setting that is implemented during public health emergencies and most of the countries have pre-existing pandemic plans; it would be advisable that, for the future (if not already happening), countries consider priority setting as a critical part of their routine health emergency and disease outbreak plans. Such an approach would ensure that priority setting is integral to pandemic planning, response and recovery.

• Africa region
• Covid-19
• Priority setting
• effective priority setting
• equity
• national plans

• India
• decentralization
• district health planning
• maternal and child health
• planning capacity

• MCDA
• disease categories
• health prioritization
• resource allocation

• Delivery of Health Care
• Greece
• Humans
• Neoplasms
• Resource Allocation

• Hepatitis C virus
• Heuristics
• Patient prioritization

• Efficiency
• Frameworks
• Health economics
• Priority setting
• Resource allocation

• US National Pharmaceutical Council

• Decision making
• MCDA
• Multi-criteria decision analysis
• Pharmaceutical policy

• Benefit package
• Insurance
• Iran
• Public preferences
• Survey

• Stakeholder participation
• Uganda
• low-income countries (LICs)
• priority setting

• Developing Countries
• Health Priorities/organization & administration
• Health Resources
• Humans
• Politics
• Poverty
• Qualitative Research
• Stakeholder Participation
• Uganda

• Ethics
• Guidelines
• Health policy
• Priority setting
• Research agenda
• Severity

• Decision Making
• Delivery of Health Care
• Health Priorities/ethics
• Humans
• Morals
• Norway
• Resource Allocation/ethics
• Severity of Illness Index
• Sweden

• Health-system priority setting
• Priority-setting frameworks
• Public participation
• Vulnerable populations

• Health Priorities/organization & administration
• Humans
• Stakeholder Participation
• Vulnerable Populations

• ethics
• healthcare rationing
• resource allocation

• HTA agencies
• multicriteria decision analysis
• priority setting
• value framework

• Decision Making
• Decision Support Techniques
• Humans
• Needs Assessment
• Quality-Adjusted Life Years
• Research Design
• Severity of Illness Index
• Technology Assessment, Biomedical/organization & administration
• Technology Assessment, Biomedical/standards

• children with disabilities
• engagement in research
• integrated knowledge translation
• priority-setting
• rehabilitation

Emergency and essential surgical, obstetric and anaesthesia (SOA) care are now recognized components of universal health coverage, necessary for a functional health system. To improve surgical care at a national level, strategic planning addressing the six domains of a surgical system is needed. This paper details a process for development of a national surgical, obstetric and anaesthesia plan (NSOAP) based on the experiences of frontline providers, Ministry of Health officials, WHO leaders, and consultants.

Development of a NSOAP involves eight key steps: Ministry support and ownership; situation analysis and baseline assessments; stakeholder engagement and priority setting; drafting and validation; monitoring and evaluation; costing; governance; and implementation. Drafting a NSOAP involves defining the current gaps in care, synthesizing and prioritizing solutions, and providing an implementation and monitoring plan with a projected cost for the six domains of a surgical system: infrastructure, service delivery, workforce, information management, finance and governance.

To date, four countries have completed NSOAPs and 23 more have committed to development. Lessons learned from these previous NSOAP processes are described in detail.

There is global movement to address the burden of surgical disease, improving quality and access to SOA care. The development of a strategic plan to address gaps across the SOA system systematically is a critical first step to ensuring countrywide scale‐up of surgical system‐strengthening activities.

• Criteria
• Health policy
• Priority setting
• Resource allocation
• Systematic review

• District health system
• Uganda
• decision-making
• evidence
• planning
• work plans

• Administrative Personnel
• Child
• Decision Making
• Delivery of Health Care
• Developing Countries
• Government Programs
• Health Planning
• Humans
• Politics
• Poverty
• Translational Research, Biomedical
• Uganda
• Work

• OPP1017016 Bill & Melinda Gates Foundation

Accountable decision-makers are required to legitimize their priority setting decisions in health to members of society. In this perspective we stress the point that fair, legitimate processes should reflect efforts of authorities to treat all stakeholders as moral equals in terms of providing all people with well-justified, reasonable reasons to endorse the decisions. We argue there is a special moral concern for being accountable to those who are potentially adversely affected by decisions. Health authorities need to operationalize this requirement into real world action. In this perspective, we operationalize five key steps in doing so, in terms of (i) proactively identifying potentially adversely affected stakeholders; (ii) comprehensively including them in the decision-making process; (iii) ensuring meaningful participation; (iv) communication of recommendations or decisions; and (v) the organization of evaluation and appeal mechanisms. Health authorities are advised to use a checklist in the form of 29 reflective questions, aligned with these five key steps, to assist them in the practical organization of legitimate priority setting in healthcare.

• Accountability for Reasonableness
• Legitimacy
• Priority Setting
• Stakeholder Participation

• Canada
• Cancer drugs
• Priority setting
• Public engagement

Background: In order to meet the challenges presented by increasing demand and scarcity of resources, healthcare organizations are faced with difficult decisions related to resource allocation. Tools to facilitate evaluation and improvement of these processes could enable greater transparency and more optimal distribution of resources.

Methods: The Resource Allocation Performance Assessment Tool (RAPAT) was implemented in a healthcare organization in British Columbia, Canada. Recommendations for improvement were delivered, and a follow up evaluation exercise was conducted to assess the trajectory of the organization’s priority setting and resource allocation (PSRA) process 2 years post the original evaluation.

Results: Implementation of RAPAT in the pilot organization identified strengths and weaknesses of the organization’s PSRA process at the time of the original evaluation. Strengths included the use of criteria and evidence, an ability to reallocate resources, and the involvement of frontline staff in the process. Weaknesses included training, communication, and lack of program budgeting. Although the follow up revealed a regression from a more formal PSRA process, a legacy of explicit resource allocation was reported to be providing ongoing benefit for the organization.

Conclusion: While past studies have taken a cross-sectional approach, this paper introduces the first longitudinal evaluation of PSRA in a healthcare organization. By including the strengths, weaknesses, and evolution of one organization’s journey, the authors’ intend that this paper will assist other healthcare leaders in meeting the challenges of allocating scarce resources.

• Evaluation
• Priority Setting
• Resource Allocation

• ART
• HIV
• VIH
• Evidence-informed deliberative processes
• Indonesia
• Indonésie
• antiretroviral therapy
• directives sur le traitement
• processus délibératifs basés sur des preuves
• treatment guidelines