'Real-world' health care priority setting using explicit decision criteria: a systematic review of the literature.
BACKGROUND
Health care decision making requires making resource allocation decisions among programs, services, and technologies that all compete for a finite resource pool. Methods of priority setting that use explicitly defined criteria can aid health care decision makers in arriving at funding decisions in a transparent and systematic way. The purpose of this paper is to review the published literature and examine the use of criteria-based methods in 'real-world' health care allocation decisions.


METHODS
A systematic review of the published literature was conducted to find examples of 'real-world' priority setting exercises that used explicit criteria to guide decision-making.


RESULTS
We found thirty-three examples in the peer-reviewed and grey literature, using a variety of methods and criteria. Program effectiveness, equity, affordability, cost-effectiveness, and the number of beneficiaries emerged as the most frequently-used decision criteria. The relative importance of criteria in the 'real-world' trials differed from the frequency in preference elicitation exercises. Neither the decision-making method used, nor the relative economic strength of the country in which the exercise took place, appeared to have a strong effect on the type of criteria chosen.


CONCLUSIONS
Health care decisions are made based on criteria related both to the health need of the population and the organizational context of the decision. Following issues related to effectiveness and affordability, ethical issues such as equity and accessibility are commonly identified as important criteria in health care resource allocation decisions.
Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Agency, Vancouver, Canada. icromwell@bccrc.ca.|Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, Canada. icromwell@bccrc.ca.
Ian
I
Cromwell
Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Agency, Vancouver, Canada. speacock@bccrc.ca.|Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, Canada. speacock@bccrc.ca.|School of Population and Public Health, University of British Columbia, Vancouver, Canada. speacock@bccrc.ca.
Stuart J
SJ
Peacock
School of Population and Public Health, University of British Columbia, Vancouver, Canada. craig.mitton@ubc.ca.|Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, Canada. craig.mitton@ubc.ca.
Craig
C
Mitton
D003362:Cost-Benefit Analysis; D003657:Decision Making; D003695:Delivery of Health Care; D006292:Health Priorities; D006801:Humans; D040841:Resource Allocation / Q000191:economics