The EVIDEM framework includes a standard set of components of decision. Components of decision were defined to reflect in an explicit manner the thinking process underlying value assessment of healthcare interventions resulting in decisionmaking. Those components that are quantifiable from a universal standpoint are organized into an MCDA Value Matrix to estimate the “intrinsic value” of the intervention. Those components that are system-related, dependent on priorities and ethics (“extrinsic value”) are organized into a tool with an ethical framework to ensure their consideration.
Quantifiable with MCDA - components were defined to fulfill MCDA guidelines on completeness, redundancy, operationality & mutual independence
- Disease impact
- D1 – Disease severity
- D2 – Size of population
- Context of intervention
- C1 – Clinical guidelines
- C2 – Comparative interventions limitations (unmet needs)
- Intervention outcomes
- I1 – Improvement of efficacy/ effectiveness
- I2 – Improvement of safety & tolerability
- I3 – Improvement of patient reported outcomes
- Type of benefit
- T1 – Public health interest (e.g., prevention, risk reduction)
- T2 – Type of medical service (e.g., cure, symptom relief)
- Economics
- E1 – Budget impact on health plan (cost of intervention)
- E2 – Cost-effectiveness of intervention
- E3 – Impact on other spending (e.g., hospitalization, disability)
- Quality of evidence
- Q1 – Adherence to requirements of decisionmaking body
- Q2 – Completeness and consistency of reporting evidence
- Q3 – Relevance and validity of evidence
Applying the MCDA Value Matrix provides a value estimate for the healthcare intervention under scrutiny which is a comprehensive measure of relative value (i.e., comparative efficacy, safety, patient reported outcomes, impact on treatment budget and other spending, cost-effectiveness) as well as absolute value (i.e., severity of disease, size of population affected, types of benefit at population and patient level, quality of evidence) while taking into consideration clinical guidelines and the limitations of alternative interventions. This estimate lays the groundwork for ethical and healthcare system related considerations (extrinsic value components).
Non quantifiable from a universal standpoint - consider impact on value of intervention (positive, neutral or negative)
- Ethical framework
- Et1 – Goals of healthcare – utility
- Et2 – Opportunity costs – efficiency
- Et3 – Population priority & access – fairness
- Other components
- O1 – System capacity & appropriate use of intervention
- O2 – Political/historical context
- O3 – Stakeholder pressures
See details on definition & design
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