P027 – Organising the Appraisal Phase in Health Benefit Package Design What is the Role Of MCDA?

An important step in any health benefit package (HBP) design process is the appraisal phase which involves the prioritization of services on the basis of scientific and social judgment on several decision criteria. Presently, countries use many different approaches to organise the appraisal phase, and there is little guidance on which approach is best in which decision-making context.

Countries need to decide on a number of key elements in their organisation of the appraisal phase: i) how to best structure the decision-making process in terms of trading off criteria? Countries can use qualitative multi-criteria decision analysis (MCDA) in which a committee deliberates on the performance of services on a number of explicit criteria; quantitative MCDA in which a committee uses scoring and weighing techniques; or decision rules in which the committee follows a hierarchical set of questions to define priorities; ii) how the governance is best organised (by a central appraisal committee, or also technical working groups to support these?); iii) how opportunity costs are best reflected in the appraisal phase (by a budget constraint or a cost-effectiveness threshold?); iv) how evidence is best presented (by showing all data or summarised in evidence briefs?), and v) how a committee arrives at recommendations (by consensus or voting?).

This session provides insight in these various approaches that countries can use to organize their appraisal phase. The session will start with a conceptual framework on the options and limitations of each of these approaches. This followed by three country case-studies on the organisation of appraisal in Rwanda, Iran and Ghana in which the presenters delve into the challenges they have faced or are still facing.

The presentation contributes to the subtheme of the conference ‘Seeing The Whole Picture: Taking A Holistic View Of Healthcare Prioritization’.