Decision Making and Priority Setting: The Evolving Path Towards Universal Health Coverage
Health technology assessment (HTA) is widely viewed as an essential component in good universal health coverage (UHC) decision-making in any country. Various HTA tools and metrics have been developed and refined over the years, including systematic literature reviews (Cochrane), economic modelling, and cost-effectiveness ratios and acceptability curves. However, while the cost-effectiveness ratio is faithfully reported in most full economic evaluations, it is viewed by many as an insufficient basis for reimbursement decisions. Emotional debates about the reimbursement of cancer drugs, orphan drugs, and end-of-life treatments have revealed fundamental disagreements about what should and should not be considered in reimbursement decisions. Part of this disagreement seems related to the equity-efficiency tradeoff, which reflects fundamental differences in priorities. All in all, it is clear that countries aiming to improve UHC policies will have to go beyond the capacity building needed to utilize the available HTA toolbox. Multi-criteria decision analysis (MCDA) offers a more comprehensive tool for reimbursement decisions where different weights of different factors/attributes can give policymakers important insights to consider. Sooner or later, every country will have to develop their own way to carefully combine the results of those tools with their own priorities. In the end, all policymaking is based on a mix of facts and values.
Francesco Paolucci, Ken Redekop, Ayman Fouda, and Gianluca Fiorentini equally contributed to the conception and development of the theoretical framework, contributed to the writing of the manuscript, and contributed to the editing of the subsequent drafts of the manuscript in light of the comments made by the reviewers for this journal. All authors gave final approval of the version to be submitted.
Compliance with Ethical Standards
Conflict of interest
Francesco Paolucci, Ken Redekop, Ayman Fouda, and Gianluca Fiorentini declare they have no conflicts of interest.
No funding was received for the paper.
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