Objectives: The aim of this study was to adapt and assess the value of a Multi-Criteria Decision Analysis (MCDA) framework (EVIDEM) for the evaluation of Orphan drugs in Catalonia (Catalan Health Service).

Methods: The standard evaluation and decision-making procedures of CatSalut were compared with the EVIDEM methodology and contents. The EVIDEM framework was adapted to the Catalan context, focusing on the evaluation of Orphan drugs (PASFTAC program), during a Workshop with sixteen PASFTAC members. The criteria weighting was done using two different techniques (nonhierarchical and hierarchical). Reliability was assessed by re-test.

Results: The EVIDEM framework and methodology was found useful and feasible for Orphan drugs evaluation and decision making in Catalonia. All the criteria considered for the development of the CatSalut Technical Reports and decision making were considered in the framework. Nevertheless, the framework could improve the reporting of some of these criteria (i.e., “unmet needs” or “nonmedical costs”). Some Contextual criteria were removed (i.e., “Mandate and scope of healthcare system”, “Environmental impact”) or adapted (“population priorities and access”) for CatSalut purposes. Independently of the weighting technique considered, the most important evaluation criteria identified for orphan drugs were: “disease severity”, “unmet needs” and “comparative effectiveness”, while the “size of the population” had the lowest relevance for decision making. Test–retest analysis showed weight consistency among techniques, supporting reliability overtime.

Conclusions: MCDA (EVIDEM framework) could be a useful tool to complement the current evaluation methods of CatSalut, contributing to standardization and pragmatism, providing a method to tackle ethical dilemmas and facilitating discussions related to decision making.

Managing for multiple ecosystem services is a growing issue for forest managers. As trade-offs arise between conflicting management objectives, stakeholders must be informed of the possible outcomes of alternative choices in order to facilitate decision-making. We modelled stand dynamics under single-management and functional zoning multiple-management (TRIAD; i.e. three-zone) scenarios in different forest types typical of eastern North America with the Forest Vegetation Simulator (FVS). Timber production, carbon stocking and habitat quality ecosystem services were calculated with simulation outputs. Habitat quality was measured using a habitat suitability index that integrated stand structural indicators. A multi-criteria decision analysis (MCDA) was performed in order to rank scenarios. We show that the most intensive management yielded greater timber volumes but resulted in the weakest carbon and habitat quality scores. The TRIAD scenarios in sugar maple–beech stands offered the best compromise in services compared to single management. In shade-intolerant deciduous stands, there was a loss of timber production with TRIAD scenarios, but greater carbon stock and habitat quality were observed. Our study contrasts alternative management scenarios for ecosystem services in woodlots of different forest types. It confirms that multiple harvest systems better achieve multiple services. The coupling of simulation modelling with MCDA offers a simple and flexible method to help stakeholders and managers make sound decisions.

Transformations of the agricultural systems have been taking place in the coastal zone of Bangladesh. In different settings, farmers have become involved in massive shrimp cultivation, shrimp–rice cultivation, rice-based improved agricultural systems or shrimp–rice–vegetable-integrated systems. The long-term livelihood, food security and adaptation of the coastal people largely depend on the sustainability of these agricultural practices. In this context, assessing the level of sustainability is extremely important. The present study attempts to examine the sustainability of agricultural practices in the coastal zone of Bangladesh. A field study was carried out in five upazilas (counties) in the coastal zone. The data were collected through in-depth questionnaire surveys, focus groups discussions, field observation, key informants and secondary materials. A comprehensive suite of indicators was developed considering productivity, efficiency, stability, durability, compatibility and equity related to the coastal agriculture. The categories and the indicators were aggregated using Multi-Criteria Decision Analysis to measure the sustainability level of five study sites. The integrated agricultural system (shrimp–rice–vegetables) of Dumuria appeared to be the most sustainable system among agricultural practices, and other integrated systems (rice-based) of Kalaroa were also found to show a good level of sustainability. The massive shrimp cultivation system of Shyamnagar and Kaliganj appears to be the least sustainable. A traditional agriculture system with some improved methods followed in Bhola Sadar also performed in a satisfactory manner. Measuring agricultural sustainability in this way produces a useful summary of sustainability issues. The information generated from the study may be used in formulating policies for this part of the country. The holistic and interdisciplinary approach employed here has the potential to a useful framework for sustainability assessment.

Objectives: This study describes the health technology assessment (HTA) framework introduced by Regione Lombardia to regulate the introduction of new technologies. The study outlines the process and dimensions adopted to prioritize, assess and appraise the requests of new technologies.

Methods: The HTA framework incorporates and adapts elements from the EUnetHTA Core Model and the EVIDEM framework. It includes dimensions, topics, and issues provided by EUnetHTA Core Model to collect data and process the assessment. Decision making is instead supported by the criteria and Multi-Criteria Decision Analysis technique from the EVIDEM consortium.

Results: The HTA framework moves along three process stages: (i) prioritization of requests, (ii) assessment of prioritized technology, (iii) appraisal of technology in support of decision making. Requests received by Regione Lombardia are first prioritized according to their relevance along eight dimensions (e.g., costs, efficiency and efficacy, organizational impact, safety). Evidence about the impacts of the prioritized technologies is then collected following the issues and topics provided by EUnetHTA Core Model. Finally, the Multi-Criteria Decision Analysis technique is used to appraise the novel technology and support Regione Lombardia decision making.

Conclusions: The VTS (Valutazione delle Tecnologie Sanitarie) framework has been successfully implemented at the end of 2011. From its inception, twenty-six technologies have been processed.

Objectives: The aim of this paper is to develop a methodological framework to facilitate the application of Multi-Criteria Decision Analysis (MCDA) for a comprehensive economic evaluation of disease management programs (DMPs).

Methods: We studied previously developed frameworks for the evaluation of DMPs and different methods of MCDA and we used practical field experience in the economic evaluation of DMPs and personal discussions with stakeholders in chronic care.

Results: The framework includes different objectives and criteria that are relevant for the evaluation of DMPs, indicators that can be used to measure how DMPs perform on these criteria, and distinguishes between the development and implementation phase of DMPs. The objectives of DMPs are categorised into a) changes in the process of care delivery, b) changes in patient lifestyle and self-management behaviour, c) changes in biomedical, physiological and clinical health outcomes, d) changes in health-related quality of life, and e) changes in final health outcomes. All relevant costs of DMPs are also included in the framework. Based on this framework we conducted a MCDA of a hypothetical DMP versus usual care.

Conclusions: We call for a comprehensive economic evaluation of DMPs that is not just based on a single criterion but takes into account multiple relevant criteria simultaneously. The framework we presented here is a step towards standardising such an evaluation.