본문 바로가기
KERD
논문KCI 등재

보건의료의사결정에 다기준결정분석(Multi-criteria decision analysis)의 활용가능성에 대한 탐색

Application of Multi-criteria Decision Analysis on Decision Making in Public Health

이지연|이혜재|배은영
한국보건경제정책학회 (The Korean Association of Health Economics and Policy)|2014.09|보건경제와 정책연구 (The Korean Journal of Health Economics and Policy)|제20권 제3호|pp. 1-24

0

조회

0

다운로드

1

인용

0

참고문헌

키워드

health technology assessment의료기술평가다기준결정분석EVIDEM보건의료자원배분약물방출스텐트Multiple-criteria decision analysisdrug-eluting stent
주제분류사회과학일반

초록

보건의료자원을 배분하는 의사결정의 합리성이 중요해지면서 여러 기준을 동시에 고려하여투명하고 체계적으로 의사결정에 도달하는 다기준결정분석 방식이 관심을 받고 있다. 본 연구에서는 문헌고찰을 통해 이 방법의 여러 유형과 특징, 해외에서 적용된 경험에 대해 고찰하고국내 사례를 통해 다기준결정분석 모형의 유용성을 평가해보았다. 문헌고찰 결과, 외국에서는 다기준결정분석 방식이 의사결정에 관여하는 각 요소를 보다 체계적으로 고려하는 효율적 방법이 될 수 있음을 확인하였다. 국내에서는 다양한 분야의 7인으로 자문회의를 구성하여 다기준결정분석 모델의 각 항목에 가중치를 부여하게 한 뒤 약물방출스텐트에 이 항목별로 점수를 매겨 최종적인 평가를 도출하였다. 그 결과, 질병의 위중도, 질병의 영향을 받는 인구집단의 규모, 보고한 근거의 완결성과 일관성, 개인의 임상적 편익, 근거의 타당성과 관련성이 비교적 높은 점수를 받았고, 재정 영향, 다른 지출에 미치는 영향 등은 점수가 낮았으며 평가자들 간의 편차도 크게 나타났다. 다기준결정분석 방식이 기존의 의사결정 방식을 대체하는 것으로 이해하는 것은 주의를 요하나 다양한 기준이 관여하는 의사결정에서 비용-효과성으로 포괄되지 않는 다른 요소들을 보다 체계적이고 투명하게 고려하는 방법으로 수용할 수 있을 것이다.

Abstract

Resource allocation and priority setting in public health is increasingly based on rational decision-making. Under this circumstance, multiple-criteria decision analysis (MCDA) that considers various criteria and provides transparent and systematic evidence raises attention. This study reviewed the features and types of MCDA, and experiences in many countries through literature review, and investigated the possible application of MCDA approaches in Korea by conducting case study. The results of literature review showed that MCDA allowed decision-makers to consider multiple factors systematically and communicate their decisions transparently. In the case study, a seven-member committee was organized and assessed the drug-eluting stent (DES) using EVIDEM framework which is one of the MCDA methods. Although MCDA approach can not substitute current decision-making method, it will facilitate systematic and transparent approach to consider multiple factors other than cost-effectiveness.

참고문헌 (26)

  1. Baeten, S. A., "Incorporating equity-efficiency interaction in cost-effectiveness analysis – three approaches applied to breast cancer control", Value in Health, 13(5), pp.573~579 (2010)
  2. Baltussen, R., "Priority setting of health interventions: the need for multi-criteria decision analysis", Cost Effectiveness and Resource Allocation, 4(14) (2006)
  3. Baltussen, R., "Towards a multi-criteria approach for priority setting: an application to Ghana", Health Economics, 15, pp.689~696 (2006)
  4. Baltussen, R., "Multi-criteria decision analysis to prioritize health interventions: capitalizing on first experiences", Health Policy, 96, pp.262~264 (2010)
  5. Baltussen, R., "Question is not whether but how to use MCDA", presented at ISPOR 16th annual european congress (2013)
  6. Claxton, K., "Should multi-criteria decision analysis (MCDA) replace cost effectiveness analysis (CEA) for evaluation of health care coverage decisions?", presented at ISPOR 16th annual european congress (2013)
  7. Defechereux, T., "Health care priority setting in Norway a multicriteria decision analysis", BMC Health Services Research, 12(39) (2012)
  8. "Multi-Criteria Analysis: A Manual" (2009)[URL]
  9. Dolan, J. G., "Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare", Patient, 3(4), pp.229~248 (2010)
  10. Goetghebeur, M. A., "Bridging health technology assessment (HTA) and efficient health care decision making with multicriteria decision analysis (MCDA): applying the EVIDEM framework to medicines appraisal", Med Decis Making, 32, pp.376~388 (2012)
  11. Goetghebeur, M.M., "Evidence and Value: Impact on DEcisionMaking – the EVIDEM framework and potential applications", BMC Health Services Research, 8 (2008)
  12. Goetghebeur, M.M., "Combining multicriteria decision analysis, ethics and health technology assessment: applying the EVIDEM decision-making framework to growth hormone for Turner syndrome patients", Cost Effectiveness and Resource Allocation, 8(4) (2010)
  13. Liberatore, M.J., "The analytic hierarchy process in medical and health care decision making: a literature review", European Journal of Operational Research, 89(1), pp.1194~1207 (2008)
  14. Miot, J., "Field testing of a multicriteria decision analysis (MCDA) framework for coverage of a screening test for cervical cancer in South Africa", Cost Effectiveness and Resource Allocation, 10(2) (2012)
  15. Mirelman, A., "Decision-making criteria among national policy makers in five countries: a discrete choice experiment eliciting relative preferences for equity and efficiency", Value in Health, 15, pp.534~539 (2012)
  16. Peacock, S., "Overcoming barriers to priority setting using interdisciplinary methods", Health Policy, 92, pp.124~132 (2009)
  17. Sloane, E.B., "Using the analytic hierarchy process as a clinical engineering tool to facilitate an iterative, multidisciplinary, microeconomic health technology assessment", Computers & Operations Research, 30(10), pp.1447~1465 (2003)
  18. Sloane, E. B., "Medical decision support using the Analytic Hierarchy Process", Journal of Healthcare Information Management, 16(4), pp.38~43 (2002)
  19. Thokala, P., "Multiple criteria decision analysis for health technology assessment", Value in Health, 15, pp.1172~1181 (2012)
  20. Tony, M., "Bridging health technologies assessment(HTA) with multicriteria decision analyses (MCDA): field testing of the EVIDEM framework for coverage decisions by a public payer in Canada", BMC Health Services Research, 11 (2011)
  21. Towse, A., "Value based pricing, research and development, and patient access schemes. Will the United Kingdom get it right or wrong?", British Journal of Clinical Pharmacology, 70(3), pp.360~366 (2010)
  22. Tromp, N., "Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers", BMC Health Services Research, 12 (2012)
  23. Wailoo, A., "Weighting must wait: incorporating equity concerns into cost-effectiveness analysis may take longer than expected", Pharmacoeconomics, 27(12), pp.983~989 (2009)
  24. Wilson, E., "Prioritizing health technologies in a Primary Care Trust", Journal of Health Services Research & Policy, 12(2), pp.80~85 (2007)
  25. Youngkong, S., "Multicriteria decision analysis for including health interventions in the universal health coverage benefit package in Thailand", Value in Health, 15, pp.961~970 (2012)
  26. Youngkong, S., "Multi-criteria decision analysis for setting priorities on HIV", AIDS interventions in Thailand, 2012, pp.10(6), ~

관련 논문AI추천

Multiple Criteria Decision Analysis (MCDA) in Health Technology Assessment: Review of Literature on MCDA Methodology and Decision Criteria김영주, 박다진, 이용주, Danny Liew한국보건의료기술평가학회 · 보건의료기술평가2017 · 제5권 제2호의약품 급여 결정과 다기준의사결정(Multiple Criteria Decision Analysis) 활용에 대한 고찰배은영, 이태진, 황소정한국보건의료기술평가학회 · 보건의료기술평가2015 · 제3권 제2호보건의료자원 배분의 우선순위 설정 기준에 대한 체계적 문헌고찰배그린, 배은영, 이보람, 임민경한국보건경제정책학회 · 보건경제와 정책연구2019 · 제25권 제4호보건분야 우선순위 설정에 대한 외국 사례 비교 및 정책적 시사점강민선, 송현종, 오주연, 정설희, 조수진한국보건경제정책학회 · 보건경제와 정책연구2008 · 제14권 제1호Appraising the Value of Medical Device Innovation in South Korea: Multi-Criteria Decision Analysis Application for Reimbursement Coverage Decision-Making이상수, 최현숙, Liesl Strachan한국보건의료기술평가학회 · 보건의료기술평가2015 · 제3권 제2호AHP를 이용한 공공병원 평가지표의 우선순위 및 가중치 개발권영대, 박은영, 심재선, 양민희, 이건세보건의료산업학회 · 보건의료산업학회지2013 · 제7권 제4호

이 간행물의 다른 논문 (3건)

금연치료제의 경제성 평가김은주, 김윤희, 박다진pp. 25-44간접흡연과 비만간의 관계 분석정완교, 김지훈pp. 45-64입원환자의 상급병실 이용행태 및 상급병실 이용에 영향을 미치는 요인오인환, 홍석원, 김아림, 김영은pp. 65-85
원문 보기