New Vaccine Development Establishing Priorities: Volume II, Diseases of Importance in Developing Countries (1986) / Chapter Skim
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2. Priority Setting for Health-Related Investments: A Review of Methods
2. Priority Setting for Health-Related Investments: A Review of Methods
Pages 19-29
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From page 19... ...
Examples of these problems include setting priorities for resource allocation to medical technologies; setting priorities in medical research; selecting chemicals for toxicity testing; and selecting hazardous waste sites for cleanup. The methods themselves draw from techniques in systems analysis, decision analysis, and cost-benefit analysis.
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From page 20... ...
This approach arrays the performance of each alternative on each valued objective, without attempting to produce an explicit overall score for each alternative. In deferring the final ranking to decision makers or consensus panels, multiattribute accounting differs from the other methods considered.
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From page 22... ...
The rest is left to intuitive judgment, which may be viewed either as an advantage or a limitation of the method. MULTIATTRIBUTE SCORING The method of multiattribute scoring goes beyond multiattribute accounting by generating a composite score for each candidate project.
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From page 24... ...
These expected values for each consequence could be combined into a composite score using the methods illustrated in Table 2.2, with expected values of valued consequences as the weighted items rather than a mixture of consequences and probabilities. More rigorous application of decision analysis would entail combining the valued consequences into a utility score for each possible scenario, prior to averaging out by the probabilities, rather than averaging out each valued consequence separately and then combining the averaged-out values.
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From page 25... ...
measure of effectiveness or expected value be defined for each candidate project. If the resource cost for the ith candidate is Ci and the expected effectiveness is Ei, then the resources will be optimized if the candidate projects are ranked in increasing order by the cost-effectiveness ratio, Ci/Ei, and selected in that rank order as far down the list as resources permit.
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From page 26... ...
Measures of economic productivity, such as earnings, often are used to monetize health improvements, but any such method has serious problems. After all valued consequences have been monetized, the calculation of expected values proceeds as in multiattribute decision analysis: probabilities of various scenarios are multiplied by the corresponding utility values (or, in benefit-cost analysis, dollar values)
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From page 27... ...
ISSUES IN PROJECT RANKING METHODOLOGIES Sources of Estimates Data from case reports, published studies, government statistics, and other sources, as well as the subjective judgments of experts, are required for all of the methods described above. Expert judgments may be elicited either informally or by such formal procedures as the Delphi method (Dalkey, 1969~.
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From page 28... ...
The needs of the world's poorer nations may be quite different from those of developing countries that have progressed further. A third criterion might be the age range of the principal target population; diseases that affect young children may be considered separately from those that attack adults in certain occupations (e.g., in some parts of the world, young men who work in forested areas have a high risk of yellow fever)
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From page 29... ...
The committee decided that an approach that combines essential features of cost-effectiveness analysis and decision analysis would be the most appropriate for ranking vaccines for accelerated development. Such an approach generates substantial information on both the expected health benefits from a vaccine and the costs of achieving those benefits.
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