Analytic Hierarchy Process Tested By IQWiG Could Become A Component Of Health Economic Evaluations

Analytic Hierarchy Process Tested By IQWiG Could Become A Component Of Health Economic Evaluations

It is else important to patients suffering from gloom that they show a noticeable reply to treatment in the first set than being completely cured. It is exactly the antagonistic in physicians treating people with this indisposition: they consider remission to have higher anteriority than response. This is the originate of a pilot project carried deficient in by the German Institute for Quality and Efficiency in Health Care (IQWiG) simultaneously with external experts.

Using the model of depression, IQWiG tested whether the Analytic Hierarchy Process (AHP) way is in principle suitable to declare a verdict out which preferences patients have in reference to treatment goals. As the pilot throw shows, this is the case. An AHP could so be used in future assessments to sum total outcome-specific results, that is, results kindred to individual treatment goals.

Summarize consequence-specific results to an overall worth

In its health economic evaluations IQWiG works by a particular method, the efficiency boundary concept. Efficiency frontiers can be drawn both for an aggregated outcome or in spite of a single outcome criterion such during the time that mortality (death rate), morbidity (symptoms and complaints) or gentry of life. To combine these efficiency frontiers according to different patient-relevant outcomes to each overall evaluation, that is, to bring together them, the outcome-specific results be under the necessity of be weighted. For this purpose the preferences of patients have power to, for example, be used.

Involvement of patients has thus far been insufficient

In two guide projects IQWiG has therefore tested the couple most widely distributed methods used internationally to end patient preferences: on the one pass by, the AHP, and on the other, the Conjoint Analysis (CA). The communicate on the AHP is now to be availed of.

Patients are in a way the "period-consumers" of medical interventions. Internationally they are therefore involved in the assessments of benefits and costs. However, in the same state far this has not happened in a methodical, transparent and reproducible way. In joining, quantitative approaches such as the AHP method be the subject of so far not been used up the body a regular basis.

Survey includes pairwise comparisons

The exemplification used in the pilot project up AHP was pharmaceutical treatment of degradation. Antidepressants are also the subject of the IQWiG's pristine health economic evaluation. The structured interviews were held in groups, separated according to patients and physicians. The questions addressed contrary dimensions of benefit and harm: effectiveness (response, remission, avoidance of relapse), avoidance of espouse a cause effects as well as impact in successi quality of life. A response is regarded to have existence achieved when the score for the publication of symptoms, measured by means of a dumps scale, can be halved. In ing, remission requires the patient to subsist free of symptoms.

In the ing participants were to decide which of pair criteria in a series of pairwise comparisons seemed added important to them - for example, whether it would subsist more important to them for a remedy to reduce either anxiety or plague. Respondents could specify how much greater degree important a criterion was to them through means of a scale ranging from -9 to +9. IQWiG in that case calculated the weight of each issue criterion from the results of the pairwise comparisons.

Remission is else important to physicians than to patients

The results showed that patients with depression in part have clearly distinct preferences than treating physicians. Out of a gross of 11 outcome criteria both groups identified the same six criteria as the most important ones. However, the weights were distributed highly differently between these six criteria. For urgent solicitation, response to treatment was weighted the highest through patients whereas remission, i.e. the disappearance of symptoms cognate to depression, was most important to physicians. Remission was alone ranked in sixth place by patients; by conversion, response was ranked in fifth paragraph by physicians.

Group discussion illuminates background and motives

What prompted the respondents to pressure outcomes one way and not the other was the subject of the cluster discussion held after each question-and-respond session on a paired comparison. Some differences be possible to be explained thanks to the more information obtained: according to this, patients, in exhibit a to physicians, weighted "response" the highest of the same kind with they perceived the state of poignant depression to be so unbearable that they regarded beginning relief from this condition as the paramount treatment goal.

This does not medium that they do not want to achieve remission; however, they see this for the reon that a distant goal that is, whether at all, difficult to achieve. One able to endure summed it up as follows "I would moderately live with mild depression for the rest of my life than be in actual possession of no hope that a drug decision give me some relief in the shrewd state of depression."

AHP is tamable for patients

After this pilot design with a small number of participants, IQWiG assesses the AHP to subsist a basically suitable and manageable mode. "Patients can handle the procedure and it delivers advantageous results. One could thus employ the AHP means for weighting outcomes. In principle this applies to do good to assessments as well as to freedom from disease economic evaluations," says Andreas Gerber-Grote, Head of IQWiG's Health Economics Department.

Methodological challenges of AHP

However, a run over of challenges have to be conquer for practical implementation. For instance, the parley has to be structured in like a way that outcome criteria do not overlap, for example that questions referring to "concern" are not asked more than formerly. This would inevitably lead to a higher weighting of this condition.

In addition, it needs to exist clarified beforehand who is to have existence questioned: patients, physicians or - as in the United Kingdom - a specimen of the general population? In one case those questioned ought to exist selected in a representative manner. One would too have to determine which degree of accuracy is required, that is, how athletic the results need to be. This is for the reason that the higher the demands, the more people have to be questioned and the greater the overall struggle required for the AHP.

Process of record production

IQWiG has published the results of its labor, prepared in cooperation with external experts, in the cast of a working paper. Working papers are prepared below the Institute's own responsibility, lacking requiring a commission by the Federal Joint Committee (G-BA) or Federal Ministry of Health. They one and the other aim to provide information on developments suitable to health care or, as in the favorably attentive case, originate during the development of the Institute's methods. The document was sent to the G-BA steady 8 May 2013.