Stakeholders apply the GRADE evidence-to-decision framework to facilitate coverage decisions

Philipp Dahm, Andrew D. Oxman, Benjamin Djulbegovic, Gordon H. Guyatt, M. Hassan Murad, Laura Amato, Elena Parmelli, Marina Davoli, Rebecca L. Morgan, Reem A. Mustafa, Shahnaz Sultan, Yngve Falck-Ytter, Elie A. Akl, Holger J. Schünemann

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives Coverage decisions are complex and require the consideration of many factors. A well-defined, transparent process could improve decision-making and facilitate decision-maker accountability. Study Design and Setting We surveyed key US-based stakeholders regarding their current approaches for coverage decisions. Then, we held a workshop to test an evidence-to-decision (EtD) framework for coverage based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results A total of 42 individuals (including 19 US stakeholders as well as international health policymakers and GRADE working group members) attended the workshop. Of the 19 stakeholders, 14 (74%) completed the survey before the workshop. Almost all of their organizations (13 of 14; 93%) used systematic reviews for coverage decision-making; few (2 of 14; 14%) developed their own evidence synthesis; a majority (9 of 14; 64%) rated the certainty of evidence (using various systems); almost all (13 of 14; 93%) denied formal consideration of resource use; and half (7 of 14; 50%) reported explicit criteria for decision-making. At the workshop, stakeholders successfully applied the EtD framework to four case studies and provided narrative feedback, which centered on contextual factors affecting coverage decisions in the United States, the need for reliable data on subgroups of patients, and the challenge of decision-making without formal consideration of resource use. Conclusion Stakeholders successfully applied the EtD framework to four case studies and highlighted contextual factors affecting coverage decisions and affirmed its value. Their input informed the further development of a revised EtD framework, now publicly available (http://gradepro.org/).

Original languageEnglish (US)
Pages (from-to)129-139
Number of pages11
JournalJournal of Clinical Epidemiology
Volume86
DOIs
StatePublished - Jun 1 2017

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Keywords

  • Coverage
  • Decision-making
  • Evidence synthesis
  • Evidence-based medicine
  • GRADE
  • Healthcare policy
  • Resource utilization
  • Systematic review

Cite this

Dahm, P., Oxman, A. D., Djulbegovic, B., Guyatt, G. H., Murad, M. H., Amato, L., ... Schünemann, H. J. (2017). Stakeholders apply the GRADE evidence-to-decision framework to facilitate coverage decisions. Journal of Clinical Epidemiology, 86, 129-139. https://doi.org/10.1016/j.jclinepi.2017.02.019

Stakeholders apply the GRADE evidence-to-decision framework to facilitate coverage decisions. / Dahm, Philipp; Oxman, Andrew D.; Djulbegovic, Benjamin; Guyatt, Gordon H.; Murad, M. Hassan; Amato, Laura; Parmelli, Elena; Davoli, Marina; Morgan, Rebecca L.; Mustafa, Reem A.; Sultan, Shahnaz; Falck-Ytter, Yngve; Akl, Elie A.; Schünemann, Holger J.

In: Journal of Clinical Epidemiology, Vol. 86, 01.06.2017, p. 129-139.

Research output: Contribution to journalArticle

Dahm, P, Oxman, AD, Djulbegovic, B, Guyatt, GH, Murad, MH, Amato, L, Parmelli, E, Davoli, M, Morgan, RL, Mustafa, RA, Sultan, S, Falck-Ytter, Y, Akl, EA & Schünemann, HJ 2017, 'Stakeholders apply the GRADE evidence-to-decision framework to facilitate coverage decisions', Journal of Clinical Epidemiology, vol. 86, pp. 129-139. https://doi.org/10.1016/j.jclinepi.2017.02.019
Dahm, Philipp ; Oxman, Andrew D. ; Djulbegovic, Benjamin ; Guyatt, Gordon H. ; Murad, M. Hassan ; Amato, Laura ; Parmelli, Elena ; Davoli, Marina ; Morgan, Rebecca L. ; Mustafa, Reem A. ; Sultan, Shahnaz ; Falck-Ytter, Yngve ; Akl, Elie A. ; Schünemann, Holger J. / Stakeholders apply the GRADE evidence-to-decision framework to facilitate coverage decisions. In: Journal of Clinical Epidemiology. 2017 ; Vol. 86. pp. 129-139.
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abstract = "Objectives Coverage decisions are complex and require the consideration of many factors. A well-defined, transparent process could improve decision-making and facilitate decision-maker accountability. Study Design and Setting We surveyed key US-based stakeholders regarding their current approaches for coverage decisions. Then, we held a workshop to test an evidence-to-decision (EtD) framework for coverage based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results A total of 42 individuals (including 19 US stakeholders as well as international health policymakers and GRADE working group members) attended the workshop. Of the 19 stakeholders, 14 (74{\%}) completed the survey before the workshop. Almost all of their organizations (13 of 14; 93{\%}) used systematic reviews for coverage decision-making; few (2 of 14; 14{\%}) developed their own evidence synthesis; a majority (9 of 14; 64{\%}) rated the certainty of evidence (using various systems); almost all (13 of 14; 93{\%}) denied formal consideration of resource use; and half (7 of 14; 50{\%}) reported explicit criteria for decision-making. At the workshop, stakeholders successfully applied the EtD framework to four case studies and provided narrative feedback, which centered on contextual factors affecting coverage decisions in the United States, the need for reliable data on subgroups of patients, and the challenge of decision-making without formal consideration of resource use. Conclusion Stakeholders successfully applied the EtD framework to four case studies and highlighted contextual factors affecting coverage decisions and affirmed its value. Their input informed the further development of a revised EtD framework, now publicly available (http://gradepro.org/).",
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AU - Murad, M. Hassan

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AU - Parmelli, Elena

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AU - Mustafa, Reem A.

AU - Sultan, Shahnaz

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AU - Akl, Elie A.

AU - Schünemann, Holger J.

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N2 - Objectives Coverage decisions are complex and require the consideration of many factors. A well-defined, transparent process could improve decision-making and facilitate decision-maker accountability. Study Design and Setting We surveyed key US-based stakeholders regarding their current approaches for coverage decisions. Then, we held a workshop to test an evidence-to-decision (EtD) framework for coverage based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results A total of 42 individuals (including 19 US stakeholders as well as international health policymakers and GRADE working group members) attended the workshop. Of the 19 stakeholders, 14 (74%) completed the survey before the workshop. Almost all of their organizations (13 of 14; 93%) used systematic reviews for coverage decision-making; few (2 of 14; 14%) developed their own evidence synthesis; a majority (9 of 14; 64%) rated the certainty of evidence (using various systems); almost all (13 of 14; 93%) denied formal consideration of resource use; and half (7 of 14; 50%) reported explicit criteria for decision-making. At the workshop, stakeholders successfully applied the EtD framework to four case studies and provided narrative feedback, which centered on contextual factors affecting coverage decisions in the United States, the need for reliable data on subgroups of patients, and the challenge of decision-making without formal consideration of resource use. Conclusion Stakeholders successfully applied the EtD framework to four case studies and highlighted contextual factors affecting coverage decisions and affirmed its value. Their input informed the further development of a revised EtD framework, now publicly available (http://gradepro.org/).

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