More than cost-effectiveness? Applying a second-stage filter to improve policy decision making.

Content Provider	Europe PMC
Author	Kan, Kaying Jörg, Frederike Lokkerbol, Joran Mihalopoulos, Cathrine Buskens, Erik Schoevers, Robert A. Feenstra, Talitha L.
Abstract	BackgroundApart from cost‐effectiveness, considerations like equity and acceptability may affect health‐care priority setting. Preferably, priority setting combines evidence evaluation with an appraisal procedure, to elicit and weigh these considerations.ObjectiveTo demonstrate a structured approach for eliciting and evaluating a broad range of assessment criteria, including key stakeholders’ values, aiming to support decision makers in priority setting.MethodsFor a set of cost‐effective substitute interventions for depression care, the appraisal criteria were adopted from the Australian Assessing Cost‐Effectiveness initiative. All substitute interventions were assessed in an appraisal, using focus group discussions and semi‐structured interviews conducted among key stakeholders.ResultsAppraisal of the substitute cost‐effective interventions yielded an overview of considerations and an overall recommendation for decision makers. Two out of the thirteen pairs were deemed acceptable and realistic, that is investment in therapist‐guided and Internet‐based cognitive behavioural therapy instead of cognitive behavioural therapy in mild depression, and investment in combination therapy rather than individual psychotherapy in severe depression. In the remaining substitution pairs, substantive issues affected acceptability. The key issues identified were as follows: workforce capacity, lack of stakeholder support and the need for change in clinicians’ attitude.ConclusionsSystematic identification of stakeholders’ considerations allows decision makers to prioritize among cost‐effective policy options. Moreover, this approach entails an explicit and transparent priority‐setting procedure and provides insights into the intended and unintended consequences of using a certain health technology.Patient contributionPatients were involved in the conduct of the study for instance, by sharing their values regarding considerations relevant for priority setting.
Page Count	11
ISSN	13696513
Journal	Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
Volume Number	24
PubMed Central reference number	PMC8369110
Issue Number	4
PubMed reference number	34061430
e-ISSN	13697625
DOI	10.1111/hex.13277
Language	English
Publisher	John Wiley and Sons Inc.
Publisher Date	2021-06-01
Publisher Place	Hoboken
Access Restriction	Open
Rights License	This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.
Subject Keyword	cost‐effectiveness analysis decision making health technology assessment major depressive disorder patient participation priority setting
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health