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

Area of Science:

• Health Economics
• Health Services Research
• Decision Science

Background:

• Health-care priority setting often overlooks factors beyond cost-effectiveness, such as equity and acceptability.
• Integrating evidence evaluation with appraisal procedures is crucial for weighing these considerations.

Purpose of the Study:

• To present a structured method for evaluating diverse assessment criteria, including stakeholder values, to aid health-care priority setting.
• To support decision-makers in making informed choices for resource allocation.

Main Methods:

• Adopted appraisal criteria from the Australian Assessing Cost-Effectiveness initiative for substitute depression care interventions.
• Conducted focus groups and semi-structured interviews with key stakeholders to assess interventions.
• Involved patients in sharing values relevant to priority-setting considerations.

Main Results:

• Identified two acceptable and realistic intervention pairs: therapist-guided/Internet-based cognitive behavioural therapy (CBT) for mild depression, and combination therapy for severe depression.
• Substantive issues like workforce capacity, stakeholder support, and clinician attitudes impacted the acceptability of other interventions.
• Provided decision-makers with an overview of considerations and recommendations.

Conclusions:

• Systematic identification of stakeholder considerations enables prioritization of cost-effective policy options.
• This approach ensures an explicit and transparent priority-setting process.
• Offers insights into the potential consequences of adopting new health technologies.