J. Marjan Hummel

A multicriteria decision analysis of augmentative treatment of upper limbs in persons with tetraplegia

This study supported the evaluation by a rehabilitation team of the performance of two treatment options that improve the arm-hand function in subjects with sixth cervical vertebra (C6) level Motor Group 2 tetraplegia. The analytic hierarchy process, a technique for multicriteria decision analysis, was used by a rehabilitation team and potential recipients to quantitatively compare a new technology, Functional Elec trical Stimulation (FES), with conventional surgery. Perform-ance was measured by functional improvement, treatment load, risks, user-friendliness, and social outcomes. Functional improvement after FES was considered better than that after conventional surgery. However, the rehabilitation teams overall rating for conventional surgery was slightly higher than that for FES (57% vs 44%). Compared with the rehabilitation team, potential recipients gave greater weight to burden of treatment and less weight to functional improvement. This study shows that evaluation of new technology must be more comprehensive than the evaluation of functional improvement alone, and that patient preferences may differ from those of the rehabilitation team.

Group Decision Making with the Analytic Hierarchy Process in Benefit-Risk Assessment: A Tutorial

The analytic hierarchy process (AHP) has been increasingly applied as a technique for multi-criteria decision analysis in healthcare. The AHP can aid decision makers in selecting the most valuable technology for patients, while taking into account multiple, and even conflicting, decision criteria. This tutorial illustrates the procedural steps of the AHP in supporting group decision making about new healthcare technology, including (1) identifying the decision goal, decision criteria, and alternative healthcare technologies to compare, (2) structuring the decision criteria, (3) judging the value of the alternative technologies on each decision criterion, (4) judging the importance of the decision criteria, (5) calculating group judgments, (6) analyzing the inconsistency in judgments, (7) calculating the overall value of the technologies, and (8) conducting sensitivity analyses. The AHP is illustrated via a hypothetical example, adapted from an empirical AHP analysis on the benefits and risks of tissue regeneration to repair small cartilage lesions in the knee.

Assessment of the added value of the Twente Photoacoustic Mammoscope in breast cancer diagnosis.

Purpose Photoacoustic (PA) imaging is a recently developed breast cancer imaging technique. In order to enhance successful clinical implementation, we quantified the potential clinical value of different scenarios incorporating PA imaging by means of multi-criteria analysis. From this analysis, the most promising area of application for PA imaging in breast cancer diagnosis is determined, and recommendations are provided to optimize the design of PA imaging. Methods The added value of PA imaging was assessed in two areas of application in the diagnostic track. These areas include PA imaging as an alternative to x-ray mammography and ultrasonography in early stage diagnosis, and PA imaging as an alternative to Magnetic Resonance Imaging (MRI) in later stage diagnosis. The added value of PA imaging was assessed with respect to four main criteria (costs, diagnostic performance, patient comfort and risks). An expert panel composed of medical, technical and management experts was asked to assess the relative importance of the criteria in comparing the alternative diagnostic devices. The judgments of the experts were quantified based on the validated pairwise comparison technique of the Analytic Hierarchy Process, a technique for multi-criteria analysis. Sensitivity analysis was applied to account for the uncertainty of the outcomes. Results Among the considered alternatives, PA imaging is the preferred technique due to its non-invasiveness, low cost and low risks. However, the experts do not expect large differences in diagnostic performance. The outcomes suggest that design changes to improve the diagnostic performance of PA imaging should focus on the quality of the reconstruction algorithm, detector sensitivity, detector bandwidth and the number of wavelengths used. Conclusion The AHP method was useful in recommending the most promising area of application in the diagnostic track for which PA imaging can be implemented, this being early diagnosis, as a substitute for the combined use of x-ray mammography and ultrasonography.

Product Design Planning with the Analytic Hierarchy Process in Inter-Organizational Networks

In the second half of inter–organizational product development, the new product is likely to face significant design changes. Our study focused on the adequacy of the analytic hierarchy process (AHP) to support the collaborative partners to steer and align the accompanying design activities. It quantitatively supported discussions between researchers, engineers, manufacturers and future users involved in the development of a voice–producing prosthesis. These discussions focused on the planning of respectively the product design objectives, design changes, and design activities. This product design planning was based on the product requirements relevant to the diverse groups involved, a pro–active view on the market circumstances, the available knowledge, skills and resources, lead–time and costs. The outcomes showed that the AHP is an adequate tool for R&D managers to support inter–organizational product development.

Predicting the health economic performance of new non-fusion surgery in adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) can lead to pain, impaired spinal function, and socio‐psychological problems. Conventional surgical treatment of severe forms of AIS fuses the vertebrae, thereby restricting spinal function and growth of the adolescents. Non‐fusion surgical treatment (NFS) is being proposed to prevent these drawbacks. To support the further development of NFS, this study aims to predict the health economic performance of the new NFS treatment and compare it with standard AIS treatment. A decision tree was constructed to compare NFS with bracing, possibly followed by posterior fusion surgery. The outcome measures were quality of life, complications, and costs. The Analytic Hierarchy Process (AHP), a technique for multi‐criteria decision analysis, supported an expert panel of biomedical engineers and orthopaedic surgeons to predict the missing NFS performance data in the decision tree. The decision tree analysis showed that NFS is the preferred form of treatment in patients prone to disease progression. The advantages are its positive effect on spinal function and the self‐esteem of the patient. Future clinical acceptance of NFS can be supported by reduced costs and an optimization of the prediction of progression. As more clinical evidence becomes available over time, these data can be added to the health economic model.

Types and timing of inter-organizational communication in new product development

Managing the communication between the participants involved in inter–organizational product development is complex. The traditional models of new product development are not sufficient to gain insight in effective management practices in this respect. Our study explored the inter–organizational communication in a research and development project. Our results confirm Gersick’s model that looks upon new product development as being punctuated by periods of rapid change. In these periods, including the start–up, explorative prototype stage, and completion of the project, inter–organizational communication is essential about design objectives and project planning, contextual factors and the required resources, skills and knowledge.

Early Assessment of the Added Value of FDG-PET/CT and MRI-DWI in Monitoring Treatment Response of Stage III Non-Small Cell Lung Cancer

In an expert panel, the future values of PET/CT and MRI-DWI for early monitoring of treatment response in stage III Non-Small Cell Lung Cancer patients were predicted. The clinical values of the two new imaging modalities were predicted relative to current practice: the use of CT alone. By means of multi-criteria decision analysis we showed the expected value of the imaging modalities in terms of clinical effectiveness, efficiency and user-friendliness. By means of a Monte Carlo simulation, we depicted the uncertainty in these values. The results show that even though CT is, in this stage, preferred by the experts, it can be worthwhile to invest in the further development and application of the two new imaging modalities considering their distinct advantages.

User Preferences for Design Scenarios of a New Imaging Technique to Detect Breast Cancer

Currently, new techniques for the detection of breast cancer are being developed that cause less patient discomfort than X-ray mammography. One of these techniques is photo-acoustic mammography. However, it is still unknown how important performance requirements related to diagnostic performance, discomfort, risks, and efficiency are to the adoption of new imaging technology in breast cancer screening. The Analytic Hierarchy Process (AHP), a technique for multi-criteria analysis, was used to estimate health care professionals’ preferences for three scenarios of the new imaging technology. These scenarios differed in the diagnostic performance that could be achieved. Preferences for the scenarios of photo-acoustic mammography were compared with the preferences for X-ray mammography. Criteria related to the diagnostic performance, efficiency, patient comfort and risks. We elicited preferences of 20 health care professionals involved in a breast cancer screening program. Health care professionals considered the sensitivity of the imaging technique to be the criterion of utmost importance in the selection of a new imaging technique to detect breast cancer. Advantages of less discomfort have relatively less meaning according to the radiology assistants and radiologists involved. Our scenario analysis indicated the minimal performance requirements for the diagnostic performance of the new imaging technique. This study supported the design and market decisions of the developers of the new imaging technique. It showed that the new technique should exceed the diagnostic performance of X-ray mammography. Reduction of the scan time appeared to be important to increase the efficiency of the breast cancer screening program.

PHP132 VALUE OF MULTI-CRITERIA DECISION ANALYSIS IN EARLY ASSESSMENT OF MEDICAL DIAGNOSTIC DEVICES

OBJECTIVES: Multicriteria decision analytic (MCDA) techniques are a powerful tool in evaluating health care interventions where multiple, often competing, factors need to be considered. The analytic hierarchy process (AHP) is one such technique. We have applied AHP to evaluate medical diagnostic technologies as to support product development and market access. The main objective of this study is to show feasibility of AHP in terms of applicability and outcome. We therefore have studied the expected performance of the Photoacoustic Mammoscope (PAM), a new imaging device for detection of breast cancer based on photoacoustic imaging. METHODS: Before starting the study we defined different diagnostic and screening scenarios for the PAM including criteria that are important in the acceptance of the device. We finally defined four strategies including mammography, ultrasound and MRI imaging. The Analytic Hierarchy Process (AHP) analysis was then used to identify the relative importance of evaluation criteria, and to identify the relative performance of four different breast cancer imaging techniques. RESULTS: According to the expert panel the most important criterion in the design of a diagnostic breast imaging device is sensitivity (overall weight was 54%). Factors that mainly determine the performance on sensitivity are the visualization of mass margins, mass shape and vascularization. Second most important criterion was safety. CONCLUSIONS: From an early assessment of photoacoustic imaging it may be concluded that the potential clinical performance justifies further development and implementation of PAM. However, further research on the use of AHP in medical product development is required. We present and discuss some ideas to further integrate clinical evidence into MCDA using Bayesian techniques as well as sensitivity analyses on the model inputs.

PIH43 EARLY ASSESSMENT OF A NEW TREATMENT FOR ADOLESCENT IDIOPATHIC SCOLIOSIS

OBJECTIVES: Adolescent idiopathic scoliosis (AIS) reduces the quality of life. It can lead to back pain, reduced back function and socio-psychological problems. Left untreated it may induce cardio-vascular and pulmonary problems, and even death. Current treatment of severe forms of idiopathic scoliosis are based on fusion of the vertebrae. These treatments restrict back function and growth of the adolescents. This study aims to conduct an early technology assessment of a new non-fusion scoliosis correction system. METHODS: The early assessment of this new treatment is supported by the Analytic Hierarchy Process (AHP), a technique for multi-criteria decision analysis. The AHP quantifies the comparison between the performances of decision alternatives under a finite set of decision criteria. An expert panel composed of six technological engineers and medical specialists compared the expected performance of the new non-fusion treatment to the performance of posterior fusion surgery for patients with severe AIS. They regarded criteria related to the quality of life, complications, user friendliness and costs. RESULTS: The expert panel considered the influence of the treatment on the quality of life to be most important (weight 0.46) followed by complications (0.35), user friendliness (0.11) and costs (0.09). They expected the new non-fusion treatment to particularly have a more positive influence on the quality of life (priority 0.73) than posterior surgery has (priority 0.27). Main disadvantage was considered to be the relative high costs of the new treatment (priority 0.37 versus 0.63). In overall, the new treatment is expected to slightly outperform the current treatment (priority 0.63 versus 0.37). CONCLUSIONS: In the absence of clinical evidence, this method provides a valuable means to systematically predict a new technology’s clinical value. The outcomes provide clear directions for medical industry to improve the future cost-effectiveness of new treatments.