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Table 2 Final criteria list for the prioritization of breast cancer interventions including weights

From: Multi-criteria decision analysis of breast cancer control in low- and middle- income countries: development of a rating tool for policy makers

  Definition Potential scoring scales Average weight* (min-max) Median weight
Effectiveness [3135] Effectiveness is the extent to which an intervention impacts the most relevant health-related outcomes (e.g. time to recurrence or healthy life years gained). In comparison of effectiveness of interventions, it is important to note that the most relevant health-related outcome should be consistent for all interventions under consideration [25]. Size of the effect (e.g. in a population of 1 million people): 17.33 (5–50) 15
0 less effective (e.g. < 50 healthy life years gained a year)
1 effective (e.g. ≥ 50 < 100 healthy life years gained a year)
2 very effective (e.g. ≥ 100 healthy life years gained a year) [36]
Quality of the evidence [31, 32, 35, 37, 38] The risk of bias and the extent of the confidence that the evidence is adequate to support a particular decision or recommendation [39]. 0 very little or limited confidence in the evidence: the estimated values may be substantially different from the outcomes in reality 11.93 (0–20) 12
1 moderately confident about the evidence: The estimated values are likely to be close to the outcomes in reality, but there is a possibility that it is different
2 very confident that the estimated values lie close to the outcomes in reality [39]
Magnitude of individual health impact [32, 38] Interventions offering small benefits for many may be viewed differently from those offering large benefits for a few. When one of the two is preferred above the other, interventions providing the preferred effect (concentrated or dispersed) might be more prioritized [32]. Scoring scale a could be used in the case that local stakeholders decide that large individual health benefits are preferred above helping more people. 8.60 (0–25) 10
Scoring scale b could be used in the case that local stakeholders decide that helping more people is preferred above large individual health benefits.
a
0 small individual health impact
1 moderate individual health impact
2 large individual health impact
b
0 benefits for just a few people.
1 benefits for a moderate number of people
2 benefits for many people
Acceptability [26, 34, 35, 38] The extent to which the intervention is judged as suitable, satisfying or attractive by different stakeholder groups (e.g. patients, providers or politicians). The acceptability depends on people their norms, beliefs and values [26, 40]. 0 the intervention is not accepted by some people and it is not likely that this can be changed 8.67 (5–15) 10
1 the intervention is not accepted by some people but it is likely that this can be changed with some extra effort (e.g. special education)
2 the intervention is accepted by almost all people
Cost-effectiveness [31, 32, 35, 37, 40] The capacity to produce the maximum output for a given monetary input [25]. 0 not cost-effective (e.g. costs per gained healthy life year are above 3*Gross Domestic Product (GDP) per capita) 12.4 (0–25) 15
1 cost-effective (e.g. costs per gained healthy life year are below 3*GDP per capita)
2 highly cost-effective (e.g. costs per gained healthy life year are below 1*GDP per capita) [41]
Technical complexity [26, 34] Other types of inputs required in addition to monetary nputs to implement and to keep providing the intervention. (These include human resource requirements, both quantitative and qualitative, and organizational requirements. The potential to integrate the intervention into an already existing health system should also be taken into account [26]. Ability to train and deliver all clinical and organizational requirements to run the intervention. 8.67 (5–15) 10
0 poor ability
1 moderately good ability
2 good ability
Affordability [26, 31, 34, 35, 38] The monetary input (e.g. capital investments and operational costs) required from the health system to implement and to keep providing the intervention [26]. 0 poor affordability (e.g. costs > 1 US$ per capita) 8.47 (0–20) 10
1 moderate affordability (e.g. costs > 0.50 ≤ 1 US$ per capita)
2 good affordability (e.g. costs ≤ 0.50 US$ per capita) [26]
Safety [31, 34] Safety is the practical certainty that adverse effects to patients or providers will not result from exposure to an intervention under defined circumstances [27]. 0 there is a risk of severe adverse effects (life threatening) to patients or a risk of adverse effects (of any kind) to providers 7.87 (0–15) 10
1 there is a risk of mild adverse effects to patients
2 there is no risk or a risk of very mild adverse effects (adverse effects which will completely recover within a month) to patients
Geographical coverage [26, 32, 34, 35] The ability of the intervention to be reached by the target population, independent of their living place [26]. 0 the intervention does not cover (most) people who live far away from cities. 5.47 (0 – 13) 5
1 the intervention does not cover some people who live far away from cities.
2 the intervention covers (almost) all people
Accessibility [32, 37] Patients with a different socioeconomic status or a different income should be able to make equal use of the intervention [32]. 0 the intervention is not accessible to many patients 10.6 (0 – 20) 13
1 the intervention is not accessible to some patients
2 the intervention is accessible to (almost) all patients
  1. *weights were calculated by asking participants to divide 100 points over the criteria according to their relative importance for the evaluation of breast cancer interventions.
  2. NOTE: References were used to identify the criteria in first instance. The Delphi study may have resulted in adaptations in definitions or scoring scales than originally found in the literature.