DEVELOPMENT OF THE ONTARIO DECISION FRAMEWORK: A VALUES BASED FRAMEWORK FOR HEALTH TECHNOLOGY ASSESSMENT

Area of Science:

• Health Technology Assessment (HTA)
• Health Policy
• Decision Science

Background:

• The Ontario Health Technology Advisory Committee (OHTAC) initially developed a decision framework for non-drug health technologies in 2007.
• A revision was commissioned in 2012 to improve usability and strengthen the framework's theoretical underpinnings.

Purpose of the Study:

• To revise and enhance the Ontario Decision Framework for guiding decisions on non-drug health technologies.
• To deepen the conceptual and theoretical foundations of the existing framework.

Main Methods:

• A multi-criteria decision-making approach was adopted.
• A 3-year committee deliberation process involved a priori consensus, a scoping review of global HTA practices, and expert presentations.
• Key attributes were categorized into context, primary appraisal (benefits, harms, economics, patient-centered care), and feasibility.

Main Results:

• The revised framework incorporates context criteria (stakeholders, adoption pressures, conflicts of interest).
• Primary appraisal includes benefits, harms, economics, and patient-centered care.
• Feasibility criteria encompass budget impact and organizational feasibility.

Conclusions:

• The revised Ontario Decision Framework aligns with global HTA practices but is distinguished by its explicit social values and integration of HTA paradigms.
• It employs a theoretical framework for optimal decision-making rather than broad social goal maximization.
• The framework provides a structured approach for evaluating non-drug health technologies based on diverse criteria.