Skip to main content

Systematic review for the development of a pharmaceutical and medical products prioritization framework



To identify and analyze the criteria, approaches, and conceptual frameworks, used for national/international priority setting.

Data sources

We performed a search of the main biomedical databases (Medline/PubMed, Embase, Centre for Reviews and Dissemination, and Cochrane), and we reviewed assessment agency websites, among other sources.

Study design

An systematic review of the literature was carried out.

Data collection

Eligibility criteria for inclusion were based on set of predefined criteria. Systematic reviews and/or qualitative studies (interviews, surveys, expert consensus, etc) that aimed to identify prioritization criteria or develop general operational frameworks for the selection of health priorities were included. A critical analysis is made of all the aspects that may be useful for any public body that intends to establish priorities in health.

Principal findings

We found that there are no standardized criteria for priority setting, although common trends have been identified regarding key elements. Eight key domains were identified: 1) need for intervention; 2) health outcomes; 3) type of benefit of the intervention; 4) economic consequences; 5) existing knowledge on the intervention/quality and uncertainties of the regarding evidence; 6) implementation and complexity of the intervention/feasibility; 7) justice and ethics; and 8) overall context.


Our review provides a thorough analysis of the relevant issues and offers key recommendations regarding considerations for developing a national prioritization framework. Findings are envisioned to be useful for different public organizations that are aiming to establish healthcare priorities.


A health technology is defined as an intervention that may be used to promote health, to prevent, diagnose or treat acute or chronic disease, or for rehabilitation. Health technologies include pharmaceuticals, devices, procedures and organizational systems used in health care [1].

The World Health Organization (WHO) state that defines health technology assessment (HTA) refers to the systematic evaluation of properties, effects, and/or impacts of health technology [2]. It is a multidisciplinary process to evaluate the social, economic, organizational and ethical issues of a health intervention or health technology [3].

The main purpose of conducting our assessment is to develop an explicit priority setting methodology to support decision-making regarding Medicines and Medical Devices to be included in Hospital Pharmacy practice. The development of a comprehensive prioritization system is the outcome essential for an important benefit to the healthcare system [4]. The aim of this research is to identify and analyze the processes and decision criteria used internationally for priority setting in order to establish a comprehensive set of strategic criteria for starting point for the development of a Medicines and Medical Devices prioritization framework.


A systematic search of the literature was carried out in December 2017, in the main biomedical electronic databases: Medline/PubMed, Embase, Centre for Reviews and Dissemination (CRD), and Cochrane. For this, a specific search strategy was designed combining the terms: “medicine”, “technology assessment, biomedical”, “technology”, “intervention” with “priority”, “prioriti*”, “selection” with “criteria”, “Setting”, “approach*”and “procedure*”. The detailed search terms for different electronic databases is listed in Additional file 1. Eligibility criteria for inclusion / exclusion were based on set of predefined criteria (Table 1). Systematic reviews and/or qualitative studies (interviews, surveys, expert consensus, etc) that aimed to identify prioritization criteria or develop general operational frameworks for the selection of health priorities were included. The web pages of the international agencies belonging to EUnetHTA and INAHTA were reviewed, and manually searched in the main scientific journal of the specialty (International Journal of Technology Assessment Health Care) [5,6,7,8]. In addition, a general search was carried out in the Google and Google Scholar search engine to locate gray literature, and bibliographic citations of included studies were reviewed. For perusal of the complete text, we selected records in which any type of pharmaceutical or medical product was assessed. It was not considered relevant to apply a methodological quality scale or gradation of evidence when not addressing a clinical research question. Data of the studies were analyzed and synthesized qualitatively.

Table 1 Criteria for the selection of studies


A total of 17 documents complied with eligibility criteria, out of which 15 were published in scientific journals [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23] and two elsewere [24, 25]. Fig. 1 details the selection process of the articles and the reasons for exclusion of potentially relevant articles. The studies showed great heterogeneity. A total of 56 potentially relevant priority setting criteria were identified, which could be grouped in eight categories: 1) Need for intervention; 2) Outcomes of intervention; 3) Type of benefit; 4) Economic consequences; 5) Existing knowledge/quality of evidence and uncertainties; 6) Implementation complexity/feasibility; 7) Justice and equity; and 8) Context. Table 2 describes these eight categories. Table 2 describes the domains and general criteria identified or proposed in these studies, detailing the conceptual terms used to classify them.

Fig. 1
figure 1

PRISMA 2009 Flow Diagram

Table 2 Priority setting criteria. Main sources

The current work includes eight studies that address the identification, selection or classification of criteria used in the international arena for the establishment of health priorities. [10,11,12,13,14,15,16] Three of the studies retrieved refer to the EVIDEM (Evidence and Value: Impact on Decision Making) tool. In this multicriteria tool, developed from a thorough analysis of the literature, the opinion of experts and different international experiences, refers to 13 universal quantitative criteria (5 domains) and 7 contextual qualitative criteria (3 domains). [10,11,12]


The results of our review show that, despite a general agreement regarding the need to establish rational and transparent procedures to prioritize medicinal products and medical devices, and a certain concordance with respect to critical domains exists, there is scarce information available on the explicit processes employed by the evaluation agencies for the establishment of priority issues [26,27,28,29].

This review can be used by different bodies interested in priorization framework. All domains and criteria have advantages and limitations, despite the fact all themes were devised rigorously. It should be noted that the present review is limited by the difficulties inherent in the bibliographic search. To improve efficiency, the search has been restricted to the title, so it is possible to have lost some relevant article despite using different combinations of keywords and related terms. In addition, in many cases this type of information is not published in scientific journals and is difficult to recover due to the serious shortcomings of the search engines of web pages, or because it is published in other languages. In any case, we believe that this would not detract from the current work, since we do not intend to describe all international experiences, but to identify those criteria and elements that may be key to the development of a national prioritization proposal. The implementation science principles for pharmacist and other healthcare providers, discovering and applying strategies designed to incorporate evidence-based interventions into routine practice is a must [30].


Our review provides a thorough analysis of the relevant issues and offers key recommendations regarding considerations for developing a national prioritization framework. Findings are envisioned to be useful for different public organizations that are aiming to establish healthcare priorities.


  1. The International Network of Agencies for Health Technology Assessment [Web site]. Edmonton: INAHTA; 2016. [Cited Jan 2018]. Available at:

  2. World Health Organization. Medical devices, health technology assessment. [web site]. Geneva: WHO; 2016. [Cited Jan 2018]. Available at:

  3. Medical Services Advisory Committee. Funding for new medical technologies and procedures: application and assessment guidelines. Canberra: Medical Services Advisory Committee; 2005.

    Google Scholar 

  4. Holm S. Goodbye to the simple solutions: the second phase of priority setting in health care. BMJ. 1998;17:1000–2.

    Article  Google Scholar 

  5. Henshall C, Oortwijn W, Stevens A, Granados A, Banta D. Priority setting for health technology assessment. Theoretical considerations and practical approaches. Priority setting subgroup of the EUR-ASSESS project. Int J Technol Assess Health Care. 1997;13(2):144–85.

    Article  CAS  Google Scholar 

  6. Bastian H, Scheibler F, Knelangen M, Zschorlich B, Nasser M, Waltering A. Choosing health technology assessment and systematic review topics: the development of priority-setting criteria for patients’ and consumers’ interests. Int J Technol Assess Health Care. 2011;27(4):348–56.

    Article  Google Scholar 

  7. Gulácsi L, Boncz I, Drummond M. Issues for countries considering introducing the “fourth hurdle”. The case of Hungary. Int J Health Technol Assess Health Care. 2004;20(3):337–41.

    Article  Google Scholar 

  8. Berg M, van der Grinten T, Klazinga N. Technology assessment, priority setting, and appropriate care in Dutch health care. Int J Technol Assess Health Care. 2004;20(1):35–43.

    Article  Google Scholar 

  9. Sibbald SL, Singer PA, Upshur R, Martin DK. Priority setting: what constitutes a success? A conceptual framework for successful priority setting. BMC Health Serv Res. 2009;9(43).

  10. Goetghebeur MM, Wagner M, Khoury H, Levitt RJ, Erickson LJ, Rindress D. Evidence and value: impact on DEcisionMaking--the EVIDEM framework and potential applications. BMC Health Serv Res. 2008;8:270.

    Article  Google Scholar 

  11. Youngkong S, Tromp N, Chitama D. The EVIDEM framework and its usefulness for priority setting across a broad range of health interventions. Cost Eff Resour Alloc. 2011;9:16.

    Article  Google Scholar 

  12. Goetghebeur MM, Wagner M, Khoury H, Levitt RJ, Erickson LJ, Rindress D. Bridging health technology assessment (HTA) and efficient health care decision making with multicriteria decision analysis (MCDA): applying the EVIDEM framework to medicines appraisal. Med Decis Mak. 2012;32(2):376–88.

    Article  Google Scholar 

  13. Guindo LA, Wagner M, Baltussen R, Rindress D, van Til J, Kind P, et al. From efficacy to equity: literature review of decision criteria for resource allocation and healthcare decision making. Cost Eff ResourAlloc. 2012;10(1):9.

    Article  Google Scholar 

  14. Golan O, Hansen P, Kaplan G, Tal O. Health technology prioritization: which criteria for prioritizing new technologies and what are their relative weights? Health Policy. 2011;102(2–3):126–35.

    Article  Google Scholar 

  15. Tanios N, Wagner M, Tony M, Baltussen R, van Til J, Rindress D, et al. Which criteria are considered in healthcare decisions? Insights from an international survey of policy and clinical decision makers. Int J Technol Assess Health Care. 2013;29(04):456–65.

    Article  Google Scholar 

  16. Tromp N, Baltussen R. Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers. BMC Health Serv Res. 2012;12:454.

    Article  Google Scholar 

  17. Pluddemann A, Heneghan C, Thompson M, Roberts N, Summerton N, Linden-Phillips L, et al. Prioritization criteria for the selection of new diagnostic technologies for evaluation. BMC Health Serv Res. 2010;10:109.

    Article  Google Scholar 

  18. Noorani HZ, Husereau DR, Boudreau R, Skidmore B. Priority setting for health technology assessments: a systematic review of current practical approaches. Int J Health Technol Assess Health Care. 2007;23(3):310–5.

    Article  Google Scholar 

  19. Agency for Healthcare Research and Quality. EPC topic nomination and selection. Bethesda: U.S.: Department of Health & human services; 2015.

    Google Scholar 

  20. Jankauskiene D, Petronyte G. A model for HTA priority setting: experience in Lithuania. Int J Technol Assess Health Care. 2013;29(4):450–5.

    Article  Google Scholar 

  21. Husereau D, Boucher M, Noorani H. Priority setting for health technology assessment at CADTH. Int J Technol Assess Health Care. 2010;26(3):341–7.

    Article  Google Scholar 

  22. Carlsson P. Health technology assessment and priority setting for health policy in Sweden. Int J Technol Assess Health Care. 2004;20(1):44–54.

    Article  Google Scholar 

  23. Mørland B, Ringard Å, Røttingen J-A. Supporting tough decisions in Norway: a healthcare system approach. Int J Technol Assess Health Care. 2010;26(04):398–404.

    Article  Google Scholar 

  24. National Institute for Health and Care Excellence. Technology appraisal topic selection; 2015 [cited Jan 2018]. Available at:

  25. The Netherlands Organisation of Health Research and Development. ZonMw summary assessment procedure; 2012 [cited Jan 2018]. Available at:

  26. Baltussen R, Niessen L. Priority setting of health interventions: the need for multi-criteria decision analysis. Cost Eff Resour Alloc. 2006;4:14.

    Article  Google Scholar 

  27. Baltussen R, Youngkong S, Paolucci F, Niessen L. Multi-criteria decision analysis to prioritize health interventions: capitalizing on first experiences. Health Policy. 2010;96(3):262–4.

    Article  Google Scholar 

  28. Devlin NJ, Sussex J. Incorporating multiple criteria in HTA. Methods and processes. London; 2011.

    Google Scholar 

  29. Marsh K, Dolan P, Kempster J, Lugon M. Prioritizing investments in public health: a multi-criteria decision analysis. J Public Health. 2012;35(3):460–6.

    Article  Google Scholar 

  30. Livet M, Haines ST, Curran GM, Seaton T, Ward C, Sorensen T, Roth McClurg M. Implementation science to advance care delivery: a primer for pharmacists and other health professionals. Pharmacotherapy. 2018.

    Article  Google Scholar 

Download references


Springer Nature waivers team.


Not applicable.

Availability of data and materials

Not applicable.

Author information

Authors and Affiliations



All authors (AFPS, MGG, MAAL, MASS, MPPJ, MTSG) contributed research and wrote one section of this paper. AFPS edited the paper as major contributor in writing the manuscript. All authors researched and wrote several sections of the paper and edited the overall paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alberto Frutos Pérez-Surio.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Additional file

Additional file 1:

Search strategy. (DOCX 11 kb)

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frutos Pérez-Surio, A., Gimeno-Gracia, M., Alcácera López, M.A. et al. Systematic review for the development of a pharmaceutical and medical products prioritization framework. J of Pharm Policy and Pract 12, 21 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: