Format

Send to

Choose Destination
Int J Technol Assess Health Care. 2017 Jan;33(2):176-182. doi: 10.1017/S0266462317000447. Epub 2017 Jun 28.

GRADE EVIDENCE TO DECISION (EtD) FRAMEWORK FOR COVERAGE DECISIONS.

Author information

1
Department of Epidemiology,Lazio Regional Health Service,ASL Roma 1,Italian Cochrane Centre,Department of Diagnostic,Clinical and Public Health Medicine,University of Modena and Reggio Emiliae.parmelli@deplazio.it.
2
Department of Epidemiology,Lazio Regional Health Service,ASL Roma 1.
3
Centre for Informed Health Choices,Norwegian Institute of Public Health.
4
Iberoamerican Cochrane Center,IIB Sant Pau-CIBERESP;Health Research Methods,Evidence,and Impact (formerly "Clinical Epidemiology and Biostatistics") and of Medicine,McMaster University.
5
Local Health Authority,Modena.
6
Global Health Unit,Norwegian Knowledge Centre for the Health Services.
7
Drug and Devices Evaluation Area,Emilia-Romagna Region,Bologna.
8
Local Health Authority ASL Roma 1,Rome.
9
Departments of Health Research Methods,Evidence,and Impact (formerly "Clinical Epidemiology and Biostatistics") and of Medicine,McMaster University.
10
Department of Epidemiology,Lazio Regional Health Service - ASL Roma 1.

Abstract

OBJECTIVES:

Coverage decisions are decisions by third party payers about whether and how much to pay for technologies or services, and under what conditions. Given their complexity, a systematic and transparent approach is needed. The DECIDE (Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence) Project, a GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group initiative funded by the European Union, has developed GRADE Evidence to Decision (EtD) framework for different types of decisions, including coverage ones.

METHODS:

We used an iterative approach, including brainstorming to generate ideas, consultation with stakeholders, user testing, and pilot testing of the framework.

RESULTS:

The general structure of the EtD includes formulation of the question, an assessment using twelve criteria, and conclusions. Criteria that are relevant for coverage decisions are similar to those for clinical recommendations from a population perspective. Important differences between the two include the decision-making processes, accountability, and the nature of the judgments that need to be made for some criteria. Although cost-effectiveness is a key consideration when making coverage decisions, it may not be the determining factor. Strength of recommendation is not directly linked to the type of coverage decisions, but when there are important uncertainties, it may be possible to cover an intervention for a subgroup, in the context of research, with price negotiation, or with restrictions.

CONCLUSIONS:

The EtD provides a systematic and transparent approach for making coverage decisions. It helps ensure consideration of key criteria that determine whether a technology or service should be covered and that judgments are informed by the best available evidence.

KEYWORDS:

Coverage decisions; GRADE

PMID:
28655365
DOI:
10.1017/S0266462317000447
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Cambridge University Press
Loading ...
Support Center