Design of a multiple criteria decision analysis framework for prioritizing high-impact health technologies in a regional health service.

OBJECTIVES: This study aims to develop a framework for establishing priorities in the regional health service of Murcia, Spain, to facilitate the creation of a comprehensive multiple criteria decision analysis (MCDA) framework. This framework will aid in decision-making processes related to the assessment, reimbursement, and utilization of high-impact health technologies. METHOD: Based on the results of a review of existing frameworks for MCDA of health technologies, a set of criteria was proposed to be used in the context of evaluating high-impact health technologies. Key stakeholders within regional healthcare services, including clinical leaders and management personnel, participated in a focus group (n = 11) to discuss the proposed criteria and select the final fifteen. To elicit the weights of the criteria, two surveys were administered, one to a small sample of healthcare professionals (n = 35) and another to a larger representative sample of the general population (n = 494). RESULTS: The responses obtained from health professionals in the weighting procedure exhibited greater consistency compared to those provided by the general public. The criteria more highly weighted were "Need for intervention" and "Intervention outcomes." The weights finally assigned to each item in the multicriteria framework were derived as the equal-weighted sum of the mean weights from the two samples. CONCLUSIONS: A multi-attribute function capable of generating a composite measure (multicriteria) to assess the value of high-impact health interventions has been developed. Furthermore, it is recommended to pilot this procedure in a specific decision context to evaluate the efficacy, feasibility, usefulness, and reliability of the proposed tool.

Influencia de la protocolización del tratamiento inicial con corticoides en la estancia y costo de las neumonías adquiridas en la comunidad. Estudio prospectivo 2015 / Influence of initial protocolized treatment with steroids in length of stay and costs of community acquired pneumonia

Objetivos. Valorar el impacto que la inclusión inicial de corticoides en el protocolo de tratamiento de un paciente con neumonía de la comunidad (NAC) puede tener en la estancia y costo de los procesos en enfermos ingresados con este diagnóstico en un hospital clínico universitario. Pacientes y métodos. Estudio prospectivo de los pacientes ingresados con el diagnóstico de NAC en los Servicios de Medicina Interna e Infecciosas durante los meses de enero a marzo de 2015; los pacientes se clasificaron en Grupo I, en caso de haber recibido esteroides desde el diagnóstico del proceso neumónico y hasta la finalización del tratamiento antibiótico y en Grupo II, si no habían recibido esteroides; la administración o no de esteroides fue realizada según la práctica clínica de cada médico responsable del paciente. Se valoró el costo según el GRD de NAC. Resultados. La edad < de 65 años es más frecuente en el grupo I que en el II, siendo el único factor diferencial entre ambas cohortes con significación estadística (p<0,05). En el análisis bivariado, las estancias medias del grupo I (5,37 vs 8,88 días) fueron significativamente menores (p<0,0005) y también lo fueron los costes (2.361 euros vs 3.907 euros) (p<0,0005). En el estudio multivariado se asociaron de forma independiente los costes altos (>3.520 euros) a los pacientes con EPOC (OR=2,602; IC95% 1,074-6,305) y al grupo II (pacientes que no habían recibido esteroides) (OR=6,2; p=0,007). Conclusiones. El no utilizar corticoides en el tratamiento de los pacientes con neumonías comunitarias se asoció, junto con el ser EPOC a un mayor coste del ingreso, valorado por el GRD/estancia diaria (AU)

Objective. The aim of the study was to analyze the impact of steroid treatment in patients with community acquired pneumonia (CAP), both in length of stay and economical cost of admission at a clinical university hospital. Patients and methods. Prospective study of admitted patients with the diagnosis of CAP, both in Internal Medicine and Infectious diseases department. The study was conducted from January to march 2015; patients receiving steroids from diagnosis to end of antibiotic treatment were classified as group I; otherwise, they were considered in group II. Administration of steroids was done according to the criteria of the responsible. Cost was stablished according to CAP Diagnostic Related Group (DRG). Results. Prevalence of patients younger than 65 year old was higher in group I (p<0.05). In bivariate analyses, mean admission time was lower in group I (5.37 vs 8.88 days) (p<0.0005) and also economical cost (2,361 euros vs 3,907 euros) (p<0.0005). In multivariate analysis, factors independently associated to higher cost (>3,520 euros) were COPD (OR=2.602; 95% CI 1.074-6.305) and group II (patients with no steroids) (OR=6.2; p=0,007). Conclusions. No administration of steroids in patients with CAP was associated, together with COPD, with higher economical cost (evaluated by DRG/length of stay) (AU)