Evidence mapping of the decision-making process of a health insurance company in a middle-income country




Poster session 4 Saturday: Evidence implementation and evaluation


Saturday 16 September 2017 - 12:30 to 14:00


All authors in correct order:

Torres M1, Gaitan H2, Grillo C3
1 Cochrane STI, Colombia
2 Clinical Research Institute, Universidad Nacional de Colombia, Colombia
3 Cochrane STI, Department of Gynecology and Obstetrics, Universidad Nacional de Colombia, Colombia
Presenting author and contact person

Presenting author:

Marcela Torres

Contact person:

Abstract text
Background: New technologies and evidence for management of high-cost pathologies surge daily in order to support clinical decisions at individual and organisational level. A health insurance company in Colombia set up a programme for the use of evidence in decision making with the support of the Clinical Research Institute of the National University of Colombia.

Objectives: To map the evidence that supports the decision-making process of a health insurance company in Colombia.

Methods: Mini-Health technology assessments (m-HTA) were created with standard methods for the following prioritised conditions: breast cancer, arthritis, pulmonary hypertension, Paroxysmal nocturnal hemoglobinuria, diabetes type 2, Transplant, Thromboprophylaxis and Alzheimer's disease. An evidence map was created in order to identify how many systematic reviews were used in the process and the quality of the evidence.

Results: Twenty-three m-HTA were requested. Nineteen m-HTA used published systematic reviews (SR) as a main source of data for the analysis. Eighteen per cent of the requested m-HTA needed to develop systematic reviews de novo due the lack of SR or high-quality SR. Twenty five systematic reviews were used in the programme. Sixteen per cent of them were Cochrane. The quality of the systematic reviews according to the AMSTAR tool was over 7/11. The quality of the overall evidence of all m-HTA was mostly low and moderate. For chronic diseases, the quality was mostly low and moderate; For cancer and Alzheimer's disease, the evidence was moderate quality; For transplant, the evidence was very low quality. We found two requested m-HTA whose PICO question did not use the adequate clinical comparators. The reason was the clinicians were using a high-cost treatment not indicated for the condition.

Conclusions: The m-HTA programme of the health insurance company helped the decision-making process by identifying evidence of efficacy, safety and indications of use that guided the clinicians and the organisation to provide better therapeutic and diagnostic options to patients.