GRADE EVIDENCE TO DECISION (EtD) FRAMEWORK FOR COVERAGE DECISIONS

Area of Science:

• Health policy and economics
• Evidence-based practice
• Decision analysis

Background:

• Coverage decisions by third-party payers are complex and require systematic approaches.
• The DECIDE Project, part of the GRADE Working Group, developed the GRADE Evidence to Decision (EtD) framework.
• The framework is designed to support informed decisions regarding healthcare technologies and services.

Purpose of the Study:

• To present the GRADE Evidence to Decision (EtD) framework tailored for coverage decisions.
• To outline a systematic and transparent method for evaluating healthcare interventions for coverage.
• To ensure coverage decisions are informed by the best available evidence.

Main Methods:

• An iterative development process involving brainstorming and stakeholder consultation.
• User testing and pilot testing of the framework were conducted.
• The framework was adapted from existing GRADE approaches for clinical recommendations.

Main Results:

• The EtD framework for coverage decisions involves formulating a question, assessing twelve criteria, and drawing conclusions.
• Criteria for coverage decisions share similarities with clinical recommendations but differ in decision-making processes and accountability.
• Cost-effectiveness is important but not always the sole determinant; recommendations can be conditional (e.g., for subgroups, research, price negotiation).

Conclusions:

• The GRADE EtD framework provides a systematic and transparent method for making healthcare coverage decisions.
• It facilitates the consideration of crucial criteria and evidence in coverage evaluations.
• The framework enhances the quality and consistency of judgments in coverage decision-making.