Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Cost Effectiveness and Resource Allocation
Published in: Cost Effectiveness and Resource Allocation 1/2014

Open Access 01-12-2014 | Research

Multi-criteria decision analysis of breast cancer control in low- and middle- income countries: development of a rating tool for policy makers

Authors: Kristie Venhorst, Sten G Zelle, Noor Tromp, Jeremy A Lauer

Published in: Cost Effectiveness and Resource Allocation | Issue 1/2014

Login to get access

Abstract

Background

The objective of this study was to develop a rating tool for policy makers to prioritize breast cancer interventions in low- and middle- income countries (LMICs), based on a simple multi-criteria decision analysis (MCDA) approach. The definition and identification of criteria play a key role in MCDA, and our rating tool could be used as part of a broader priority setting exercise in a local setting. This tool may contribute to a more transparent priority-setting process and fairer decision-making in future breast cancer policy development.

Methods

First, an expert panel (n = 5) discussed key considerations for tool development. A literature review followed to inventory all relevant criteria and construct an initial set of criteria. A Delphi study was then performed and questionnaires used to discuss a final list of criteria with clear definitions and potential scoring scales. For this Delphi study, multiple breast cancer policy and priority-setting experts from different LMICs were selected and invited by the World Health Organization. Fifteen international experts participated in all three Delphi rounds to assess and evaluate each criterion.

Results

This study resulted in a preliminary rating tool for assessing breast cancer interventions in LMICs. The tool consists of 10 carefully crafted criteria (effectiveness, quality of the evidence, magnitude of individual health impact, acceptability, cost-effectiveness, technical complexity, affordability, safety, geographical coverage, and accessibility), with clear definitions and potential scoring scales.

Conclusions

This study describes the development of a rating tool to assess breast cancer interventions in LMICs. Our tool can offer supporting knowledge for the use or development of rating tools as part of a broader (MCDA based) priority setting exercise in local settings. Further steps for improving the tool are proposed and should lead to its useful adoption in LMICs.
Appendix
Available only for authorised users
Literature
1.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010,127(Suppl 12):2893–2917.PubMedCrossRef
2.
Porter P: “Westernizing” women’s risks? Breast cancer in lower-income countries. N Engl J Med 2008,358(Suppl 3):213–216.PubMedCrossRef
3.
World Health Organization: The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2008.
4.
Kamangar F, Dores GM, Anderson WF: Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 2006,24(Suppl 14):2137–2150.PubMedCrossRef
5.
6.
Goddard M, Hauck K, Smith PC: Priority setting in health - a political economy perspective. Health Econ Policy Law 2006, 1: 79–90.PubMedCrossRef
7.
Muir Gray JA: Evidence based policy making: is about taking decisions based on evidence and the needs and values of the population. BMJ 2004,329(Suppl 7473):988–989.PubMedCentralPubMedCrossRef
8.
Persad G, Wertheimer A, Emanuel EJ: Principles for allocation of scarce medical interventions. Lancet 2009,373(Suppl 9661):423–431.PubMedCrossRef
9.
Evans DB, Lim SS, Adam T, Edejer TT: Evaluation of current strategies and future priorities for improving health in developing countries. BMJ 2005,331(Suppl 7530):1457–1461.PubMedCentralPubMedCrossRef
10.
Laxminarayan R, Mills AJ, Breman JG, Measham AR, Alleyne G, Clarson M, Jha P, Musgrove P, Chow J, Shahid-Salles S, Jamison DT: Advancement of global health: key messages from the Disease Control Priorities Project. Lancet 2006,367(Suppl 9517):1193–1208.PubMedCrossRef
11.
Oliver A, Mossialos E, Robinson R: Health technology assessment and its influence on health-care priority setting. Int J Technol Assess Health Care 2004,20(Suppl 1):1–10.PubMed
12.
Anderson BO, Yip CH, Ramsey SD, Bengoa R, Braun S, Fitch M, Groot M, Sandcho-Garnier H, Tsu VD: Breast cancer in limited-resource countries: health care systems and public policy. Breast J 2006,12(Suppl 1):S54–69.PubMedCrossRef
13.
Breen N, Kessler LG, Brown ML: Breast cancer control among the underserved–an overview. Breast Cancer Res Treat 1996,40(Suppl 1):105–115.PubMedCrossRef
14.
Reichenbach L: The politics of priority setting for reproductive health: breast and cervical cancer in Ghana. Reprod Health Matters 2002,10(Suppl 20):47–58.PubMedCrossRef
15.
Baltussen R, Niessen L: Priority setting of health interventions: the need for multi-criteria decision analysis. Cost Eff Resour Alloc 2006, 4: 14. 10.1186/1478-7547-4-14PubMedCentralPubMedCrossRef
16.
Baltussen R, Mikkelsen E, Tromp N, Hurtig A, Byskov J, Olsen O, Bærøe K, Hontelez JA, Singh J, Norheim OF: Balancing efficiency, equity and feasibility of HIV treatment in South Africa - development of programmatic guidance. Cost Eff Resour Alloc 2013,11(Suppl 1):26.PubMedCentralPubMedCrossRef
17.
Devlin NJ, Sussex J: Incorporating Multiple Criteria in HTA. Methods and Processes. London: Office of Health Economics; 2011.
18.
Dodgson JS, Spackman M, Pearman A, Phillips LD: Multi-Criteria Analysis: A Manual. London: Department for Communities and Local Government; 2009.
19.
Dolan JG: Multi-criteria clinical decision support: a primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare. Patient 2010,3(Suppl 4):229–248.PubMedCentralPubMedCrossRef
20.
Baltussen R, Stolk E, Chisholm D, Aikins M: Towards a multi-criteria approach for priority setting: an application to Ghana. Health Econ 2006,15(Suppl 7):689–696.PubMedCrossRef
21.
Baltussen R, Youngkong S, Paolucci F, Niessen L: Multi-criteria decision analysis to prioritize health interventions: capitalizing on first experiences. Health Policy 2010,96(Suppl 3):262–264.PubMedCrossRef
22.
Youngkong S, Baltussen R, Tantivess S, Koolman X, Teerawattananon Y: Criteria for priority setting of HIV/AIDS interventions in Thailand: a discrete choice experiment. BMC Health Serv Res 2010, 10: 197. 10.1186/1472-6963-10-197PubMedCentralPubMedCrossRef
23.
Youngkong S, Baltussen R, Tantivess S, Mohara A, Teerawattananon Y: Multicriteria decision analysis for including health interventions in the universal health coverage benefit package in Thailand. Value Health 2012,15(Suppl 6):961–970.PubMedCrossRef
24.
Hipgrave DB, Alderman KB, Anderson I, Soto EJ: Health sector priority setting at meso-level in lower and middle income countries: lessons learned, available options and suggested steps. Soc Sci Med 2014, 102: 190–200.PubMedCrossRef
25.
26.
World Health Organization: Global Status Report on Noncommunicable Diseases. Geneva: World Health Organization; 2010.
27.
World Health Organization: IPCS Risk Assessment Terminology. Geneva: World Health Organization; 2004.
28.
29.
Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Broers M, Bouter LM, Knipschild PG: The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 1998,51(Suppl 12):1235–1241.PubMedCrossRef
30.
Scheibe M, Skutsch M, Schofer J: Experiments in Delphi Methodology. In The Delphi Method: Techniques and Applications. Boston: Addison-Wesley Publishing Company; 2002.
31.
Goetghebeur MM, Wagner M, Khoury H, Evitt RJ, Erickson LJ, Rindress D: Evidence and value: impact on decision making–the EVIDEM framework and potential applications. BMC Health Serv Res 2008, 8: 270. 10.1186/1472-6963-8-270PubMedCentralPubMedCrossRef
32.
Baltussen R, Norheim OF, Johri M: Fairness in service choice: an important yet underdeveloped path to universal coverage. Trop Med Int Health 2011,16(Suppl 7):838–839.PubMedCrossRef
33.
Southwark NHS: Policy on Prioritisation for Investment and Disinvestment in Health Services. London: NHS Southwark CCG; 2010.
34.
Hanvoravongchai P: Health system and equity perspectives in health technology assessment. J Med Assoc Thai 2008,91(Suppl 2):S74–87.PubMed
35.
The NHS Confederation: Priority Setting: An Overview. London: NHS Confederation; 2007.
36.
Zelle SG, Nyarko KM, Bosu WK, Aikins M, Niëns LM, Lauer JA, Sepulveda CR, Hontelez JA, Baltussen R: Costs, effects and cost-effectiveness of breast cancer control in Ghana. Trop Med Int Health 2012,17(Suppl 8):1031–1043.PubMedCrossRef
37.
National Institute for health and Clinical Excellence: Social Value Judgements: Principles for the Development of NICE Guidance. London: NICE; 2005.
38.
Confederation NHS: Priority Setting: Strategic Planning. London: NHS Confederation; 2008.
39.
Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH: GRADE guidelines: 3 rating the quality of evidence. J Clin Epidemiol 2011,64(Suppl 4):401–406.PubMedCrossRef
40.
Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C, Fernandez M: How we design feasibility studies. Am J Prev Med 2009,36(Suppl 5):452–457.PubMedCentralPubMedCrossRef
41.
42.
Peacock S, Mitton C, Bate A, McCoy B, Donaldson C: Overcoming barriers to priority setting using interdisciplinary methods. Health Policy 2009,92(Suppl 2–3):124–132.PubMedCrossRef
43.
44.
Kapiriri L, Norheim OF: Criteria for priority-setting in health care in Uganda: exploration of stakeholders’ values. Bull World Health Organ 2004,82(Suppl 3):172–179.PubMedCentralPubMed
45.
Tromp N, Baltussen R: Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers. BMC Health Serv Res 2012, 12: 454. 10.1186/1472-6963-12-454PubMedCentralPubMedCrossRef
Metadata
Title
Multi-criteria decision analysis of breast cancer control in low- and middle- income countries: development of a rating tool for policy makers
Authors
Kristie Venhorst
Sten G Zelle
Noor Tromp
Jeremy A Lauer
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Cost Effectiveness and Resource Allocation / Issue 1/2014
Electronic ISSN: 1478-7547
DOI
https://doi.org/10.1186/1478-7547-12-13

Other articles of this Issue 1/2014

Cost Effectiveness and Resource Allocation 1/2014 Go to the issue

Research

Cost-effectiveness of a universal strategy of brief dietary intervention for primary prevention in primary care: population-based cohort study and Markov model

Research

Economic evaluation of rivaroxaban in stroke prevention for patients with atrial fibrillation in Greece

Research

Ownership and technical efficiency of hospitals: evidence from Ghana using data envelopment analysis

Research

Does technique matter; a pilot study exploring weighting techniques for a multi-criteria decision support framework

Methodology

The impact of incorporating Bayesian network meta-analysis in cost-effectiveness analysis - a case study of pharmacotherapies for moderate to severe COPD

Methodology

Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis