title: Multi-criteria decision analysis of breast cancer control in low- and middle- income countries: development of a rating tool for policy makers.
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.
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands ; Knowledge Institute of Medical Specialists, Utrecht, The Netherlands.
authors.forename: Kristie
authors.initials: K
authors.lastname: Venhorst
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Sten G
authors.initials: SG
authors.lastname: Zelle
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Noor
authors.initials: N
authors.lastname: Tromp
authors.affiliation: Costs, Effectiveness, Expenditure and Priority Setting, World Health Organization, Geneva, Switzerland.
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Lauer
keywords: Breast cancer; Multi-criteria decision analysis; Priority setting