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GRADE EVIDENCE TO DECISION (EtD) FRAMEWORK FOR COVERAGE DECISIONS.

Elena Parmelli1, Laura Amato2, Andrew D Oxman3

  • 1Department of Epidemiology,Lazio Regional Health Service,ASL Roma 1,Italian Cochrane Centre,Department of Diagnostic,Clinical and Public Health Medicine,University of Modena and Reggio Emiliae.parmelli@deplazio.it.

International Journal of Technology Assessment in Health Care
|June 29, 2017
PubMed
Summary
This summary is machine-generated.

The GRADE Evidence to Decision (EtD) framework offers a systematic approach for healthcare coverage decisions. It ensures complex choices consider evidence and key criteria for informed payer decisions.

Keywords:
Coverage decisionsGRADE

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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.