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<DIV><B>From:</B> <A title=ruglucia@PAHO.ORG
href="mailto:ruglucia@PAHO.ORG">Ruggiero, Mrs. Ana Lucia (WDC)</A> </DIV>
<DIV style="FONT: 10pt arial">
<DIV> <A title=EQUIDAD@LISTSERV.PAHO.ORG
href="mailto:EQUIDAD@LISTSERV.PAHO.ORG">EQUIDAD@LISTSERV.PAHO.ORG</A>
</DIV></DIV>
<DIV><FONT face=Arial size=2></FONT><BR></DIV>
<DIV class=Section1>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><B><FONT face=Arial color=#993300
size=2><SPAN
style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #993300; FONT-FAMILY: Arial">Priority
setting of health interventions: The need for multi-criteria decision
analysis<o:p></o:p></SPAN></FONT></B></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Rob
Baltussen and Louis Niessen <o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=1><SPAN
style="FONT-SIZE: 8pt; COLOR: #333399; FONT-FAMILY: Arial">Institute for Medical
Technology Assessment (iMTA), ErasmusMC Rotterdam, <st1:place
w:st="on"><st1:City w:st="on">Rotterdam</st1:City></st1:place>, The
Netherlands<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=1><SPAN
style="FONT-SIZE: 8pt; COLOR: #333399; FONT-FAMILY: Arial">Department of Public
Health, University Medical Centre <st1:City w:st="on">Nijmegen</st1:City>,
<st1:City w:st="on">Nijmegen</st1:City>, The <st1:place
w:st="on"><st1:country-region
w:st="on">Netherlands</st1:country-region></st1:place><o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=1><SPAN
style="FONT-SIZE: 8pt; COLOR: #333399; FONT-FAMILY: Arial">Department of Health
Policy and Management, ErasmusMC, <st1:City w:st="on">Rotterdam</st1:City>, The
<st1:place w:st="on"><st1:country-region
w:st="on">Netherlands</st1:country-region></st1:place><o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><B><I><FONT face=Arial
color=#333399 size=2><SPAN
style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #333399; FONT-STYLE: italic; FONT-FAMILY: Arial">Cost
Effectiveness and Resource Allocation </SPAN></FONT></I></B><B><FONT face=Arial
color=#333399 size=2><SPAN
style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">2006</SPAN></FONT></B><FONT
face=Arial color=#333399 size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">, 4:14
doi:10.1186/1478-7547-4-14<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial color=navy size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">
</SPAN></FONT><FONT face=Arial color=#333399 size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Available online at:
<A href="http://www.resource-allocation.com/content/4/1/14"><FONT
color=#333399><SPAN
style="COLOR: #333399">http://www.resource-allocation.com/content/4/1/14</SPAN></FONT></A>
<o:p></o:p></SPAN></FONT></P>
<P class=xfull style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">“….Priority setting
of health interventions is often ad-hoc and resources are not used to an optimal
extent. Underlying problem is that multiple criteria play a role and decisions
are complex. Interventions may be chosen to maximize general population health,
to reduce health inequalities of disadvantaged or vulnerable groups, ad/or to
respond to life-threatening situations, all with respect to practical and
budgetary constraints. This is the type of problem that policy makers are
typically bad at solving rationally, unaided. They tend to use heuristic or
intuitive approaches to simplify complexity, and in the process, important
information is ignored. Next, policy makers may select interventions for only
political motives.<o:p></o:p></SPAN></FONT></P>
<P class=xfull style="MARGIN-LEFT: 0.5in"
xmlns:m="http://www.w3.org/1998/Math/MathML"><FONT face=Arial color=#333399
size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">This
indicates the need for rational and transparent approaches to priority setting.
Over the past decades, a number of approaches have been developed, including
evidence-based medicine, burden of disease analyses, cost-effectiveness
analyses, and equity analyses. However, these approaches concentrate on single
criteria only, whereas in reality, policy makers need to make choices taking
into account multiple criteria simultaneously. Moreover, they do not cover all
criteria that are relevant to policy makers.<o:p></o:p></SPAN></FONT></P>
<P class=xfull style="MARGIN-LEFT: 0.5in"
xmlns:m="http://www.w3.org/1998/Math/MathML"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Therefore, the
development of a multi-criteria approach to priority setting is necessary, and
this has indeed recently been identified as one of the most important issues in
health system research. In other scientific disciplines, multi-criteria decision
analysis is well developed, has gained widespread acceptance and is routinely
used. This paper presents the main principles of multi-criteria decision
analysis. There are only a very few applications to guide resource allocation
decisions in health. We call for a shift away from present priority setting
tools in health – that tend to focus on single criteria – towards transparent
and systematic approaches that take into account all relevant criteria
simultaneously</SPAN></FONT>…..”</P></DIV></BODY></HTML>