INTEGRATE-HTA How to integrate apples and oranges? – A systematic review of approaches to integrate different dimensions in HTA P. Wahlster a, R. Baltussen b, L. Brereton c, J. Burns d, B. Hofmann e, K. Mozygemba a, W. Oortwijn f, S. Polus d, E. Rehfuess d, G.J. van der Wilt b, A. Gerhardus a a Department for Health Services Research, University of Bremen, Bremen, Germany b Department of Primary and Community Care, Radboud university medical center, The Netherlands c School of Health and Related Research (ScHARR) Section of Public Health, Sheffield, United Kingdom d Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Germany e University of Oslo, Centre of Methical Ethics at the Institute for Health and Society at the Faculty of Medicine, Norway f ECORYS, Health Unit, Rotterdam, The Netherlands This project is co-funded by the European Union under the Seventh Framework Programme (Grant Agreement No )

Definition of HTA HTA is a “…multidisciplinary process that summarises information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner…” (EUnetHTA n.d.) What are the apples in HTA? What are the oranges? INTEGRATE-HTA

Apples and oranges in HTA of palliative care The variety of assessed aspects Example : Hospitalization, „good death“, continuity of care The assessment results Example: Effectiveness: effect size for several outcome parameters like mortality, morbidity, quality of life etc. Ethics: several identified issues like the importance of patient autonomy in palliative care Context as modifying factor and factor of uncertainty Example: socio-cultural factors like religion Values, preferences and understanding of all relevant stakeholders, including decision-makers INTEGRATE-HTA d_Orange_-_they_do_not_compare.jpg?uselang=de One decision

How can we achieve an integrated view on apples and oranges? INTEGRATE-HTA

Aim of this study INTEGRATE-HTA This study aims to present a comprehensive overview of approaches to cover different aspects of integration in HTA.

Methods INTEGRATE-HTA Information sources and search Web of Science; Medline, PsycINFO and the non-medical databases Econlit, ASSIA, International Bibliography of the Social Sciences, Sociological abstracts were searched from January 2004 up to April Inclusion criteria Methods including multiple, quantitative or qualitative aspects Should include connective elements to merge criteria/ aggregate criteria/ address interdependencies between criteria Address aspects of the data extraction framework about integration Exclusion criteria Simply side-by-side assessment, frameworks that only provide decision criteria

Results of search strategy INTEGRATE-HTA  30 approaches included in the synthesis records assigned to the approach that was applied Records excluded (Different topic e.g. basic research) 3848 Records identified after dublicates removed.

INTEGRATE-HTA Data extraction 30 approaches: MCDA approaches Analytic approaches Preference elicitation approaches Consensus methods Do they address… Evidence issues e.g. effect sizes, context, uncertainty Judgment and evaluation issues e.g. values and preferences Decision issues e.g. comparissons to other technologies

INTEGRATE-HTA Extracted techniques of Integration a.The separation of a decision into criteria b.Structuring criteria c.Performance matrix d.Qualitative modelling techniques e.Process based integration f.Scoring and calculation techniques to integrate criteria g.Techniques as input for deliberative discussions h.Techniques for a structured deliberative discussion i.Integrating uncertainty by addressing preferences and using criteria j.Quantitative modelling techniques to address uncertainty of evidence

Apples and oranges in palliative care Integration of assessed aspects a.The separation of a decision into criteria b.Structuring criteria The assessment results c.Performance matrix Context as modifying factor d.Qualitative modelling techniques Uncertainty i.Integrating uncertainty by preferences and criteria j.Quantitative modelling techniques to address uncertainty of evidence Values, preferences and understanding of all relevant stakeholders, including decision-makers e. Process based integration f.Scoring and calculation techniques to integrate criteria h.Techniques for a structured deliberative discussion INTEGRATE-HTA d_Orange_-_they_do_not_compare.jpg?uselang=de One decision

Conclusion INTEGRATE-HTA The results of this review provide guidance on suitable combinations of different methods. All identified techniques can be used in an additive manner as they all cover different aspects of integration.

This project is co-funded by the European Union under the Seventh Framework Programme (Grant Agreement No ) INTEGRATE-HTA

This project is co-funded by the European Union under the Seventh Framework Programme (Grant Agreement No ) Please join us at the final conference of the INTEGRATE-HTA-Project at 12/13 November in Amsterdam INTEGRATE-HTA