TESTING MULTI-CRITERIA DECISION ANALYSIS FOR MORE TRANSPARENT RESOURCE-ALLOCATION DECISION MAKING IN COLOMBIA.
OBJECTIVE
In 2012, Colombia experienced an important institutional transformation after the establishment of the Health Technology Assessment Institute (IETS), the disbandment of the Regulatory Commission for Health and the reassignment of reimbursement decision-making powers to the Ministry of Health and Social Protection (MoHSP). These dynamic changes provided the opportunity to test Multi-Criteria Decision Analysis (MCDA) for systematic and more transparent resource-allocation decision-making.


METHODS
During 2012 and 2013, the MCDA framework Evidence and Value: Impact on Decision Making (EVIDEM) was tested in Colombia. This consisted of a preparatory stage in which the investigators conducted literature searches and produced HTA reports for four interventions of interest, followed by a panel session with decision makers. This method was contrasted with a current approach used in Colombia for updating the publicly financed benefits package (POS), where narrative health technology assessment (HTA) reports are presented alongside comprehensive budget impact analyses (BIAs).


RESULTS
Disease severity, size of population, and efficacy ranked at the top among fifteen preselected relevant criteria. MCDA estimates of technologies of interest ranged between 71 to 90 percent of maximum value. The ranking of technologies was sensitive to the methods used. Participants considered that a two-step approach including an MCDA template, complemented by a detailed BIA would be the best approach to assist decision-making in this context. Participants agreed that systematic priority setting should take place in Colombia.


CONCLUSIONS
This work may serve as the basis to the MoHSP on its interest of setting up a systematic and more transparent process for resource-allocation decision-making.
T.H. Chan Harvard School of Public Health,Global Health & Population,Bogotá,Colombia.
Hector Eduardo
HE
Castro Jaramillo
LASER ANALYTICA,Montreal and School of Public Health,University of Montreal,Montreal,Quebec,Canada.
Mireille
M
Goetghebeur
Universidad Externado de Colombia,Bogotá,Colombiaornellamorenomattar@gmail.com.
Ornella
O
Moreno-Mattar
D003105:Colombia; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003661:Decision Support Techniques; D015276:Health Care Rationing / Q000379:methods*; D006801:Humans; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D013673:Technology Assessment, Biomedical / Q000379:methods*
Decision making; Multiple-criteria decision analysis; Resource allocation