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Can multi-criteria decision analysis (MCDA) be implemented into real-world drug decision-making processes? A Canadian provincial experience

Published online by Cambridge University Press:  07 August 2020

Tracey-Lea Laba*
Affiliation:
The University of British Columbia, Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada The Centre for Health Economics Research and Evaluation, Business School, The University of Technology, Sydney, Australia
Bashir Jiwani
Affiliation:
Fraser Health, Ethics and Diversity Services, Surrey, Canada
Craig Mitton
Affiliation:
The University of British Columbia, Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada
*
Author for correspondence: Tracey-Lea Laba, E-mail: tracey.laba@chere.uts.edu.au

Abstract

Objective

To describe the implementation of multi-criteria decision analysis (MCDA) into a Canadian public drug reimbursement decision-making process, identifying the aspects of the MCDA approach, and the context that promoted uptake.

Methods

Narrative summary of case study describing the how, when, and why of implementing MCDA.

Results

Faced with a fixed budget, a pipeline of expensive but potentially valuable drugs, and potential delays to drug decision making, the Ministry of Health (i.e., decision makers) and its independent expert advisory committee (IAB) sought alternative values-based decision processes. MCDA was considered highly compatible with current processes, but the ability as a stand-alone intervention to address issues of opportunity cost was unclear. The IAB nevertheless collaboratively voted to implement an externally developed MCDA with support from decision makers. After several months of engagement and piloting, implementation was rapid and leveraged strong pre-existing formal and informal communication networks. The IAB as a whole rates new submissions which serves as an input into the deliberative process.

Conclusions

MCDA can be a highly adaptable approach that can be implemented into a functioning drug reimbursement setting when facilitated by (i) a truly limited budget; (ii) a shared vision for change by end-users and decision makers; (iii) using pre-existing deliberative processes; and (iv) viewing the approach as a decision framework rather than the decision (when appropriate). Given the current limitations of MCDA, implementing an academically imperfect tool first and evaluating later reflects a practical solution to real-time fiscal constraints and impending delays to drug approvals that may be faced by decision makers.

Type
Policy
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Chalkidou, K, Lopert, R, Gerber, A. [Internet] Paying for “end-of-life” drugs in Australia, Germany, and the United Kingdom: Balancing policy, pragmatism, and societal values. Issues Int Health Policy. 2012;2:1576. [cited 2020 Mar 21]. Available from: https://www.issuelab.org/resources/13197/13197.pdf.Google Scholar
Cleemput, I, Neyt, M, Thiry, N, De Laet, C, Leys, M. Using threshold values for cost per quality-adjusted life-year gained in healthcare decisions. Int J Technol Assess Health Care. 2011;27:71–6.CrossRefGoogle ScholarPubMed
Grössmann, N, Wild, C. Between January 2009 and April 2016, 134 novel anticancer therapies were approved: What is the level of knowledge concerning the clinical benefit at the time of approval? ESMO Open. 2017;1:e000125.CrossRefGoogle Scholar
Cohen, D. Cancer drugs: High price, uncertain value. Br Med J. 2017;359:j4543.CrossRefGoogle ScholarPubMed
Wieseler, B, McGauran, N, Kaiser, T. New drugs: Where did we go wrong and what can we do better? Br Med J. 2019;366:l4340.CrossRefGoogle ScholarPubMed
Nicod, E, Berg Brigham, K, Durand-Zaleski, I, Kanavos, P. Dealing with uncertainty and accounting for social value judgments in assessments of orphan drugs: Evidence from four European countries. Value Health. 2017;20:919–26.CrossRefGoogle ScholarPubMed
Luzzatto, L, Hyry, HI, Schieppati, A, Costa, E, Simoens, S, Schaefer, F et al. Outrageous prices of orphan drugs: A call for collaboration. Lancet. 2018;392:791–94.CrossRefGoogle Scholar
Angelis, A, Kanavos, P. Value-based assessment of new medical technologies: Towards a robust methodological framework for the application of multiple criteria decision analysis in the context of health technology assessment. Pharmacoeconomics. 2016;34:435–46.CrossRefGoogle ScholarPubMed
Marsh, K, IJzerman, M, Thokala, P, Baltussen, R, Boysen, M, Kalo, Z et al. Multiple criteria decision analysis for health care decision making--emerging good practices: Report 2 of the ISPOR MCDA emerging good practices task force. Value Health. 2016;19:125–37.CrossRefGoogle ScholarPubMed
Thokala, P, Devlin, N, Marsh, K, Baltussen, R, Boysen, M, Kalo, Z et al. Multiple criteria decision analysis for health care decision making—An introduction: Report 1 of the ISPOR MCDA emerging good practices task force. Value Health. 2016;19:113.CrossRefGoogle Scholar
Tony, M, Wagner, M, Khoury, H, Rindress, D, Papastavros, T, Oh, P et al. Bridging health technology assessment (HTA) with multicriteria decision analyses (MCDA): Field testing of the EVIDEM framework for coverage decisions by a public payer in Canada. BMC Health Serv Res. 2011;11:329.CrossRefGoogle ScholarPubMed
Daniels, N. Combining A4R and MCDA in priority setting for health. Cost Eff Resour Alloc. 2018; 16:51.Google ScholarPubMed
Banta, D. The development of health technology assessment. Health Policy. 2003;63:121–32.CrossRefGoogle ScholarPubMed
Scotland, G, Bryan, S. Why do health economists promote technology adoption rather than the search for efficiency? A proposal for change in our approach to economic evaluation in health care. Med Decis Making. 2017;37:139–47.CrossRefGoogle Scholar
Soril, LJJ, Niven, DJ, Esmail, R, Noseworthy, TW, Clement, FM. Untangling, unbundling, and moving forward: Framing health technology reassessment in the changing conceptual landscape. Int J Technol Assess Health Care. 2018;34:212–17.CrossRefGoogle ScholarPubMed
Franken, M, Heintz, E, Gerber-Grote, A, Raftery, J. Health economics as rhetoric: The limited impact of health economics on funding decisions in four European countries. Value Health. 2016;19:951–56.CrossRefGoogle ScholarPubMed
Birch, S, Gafni, A. The biggest bang for the buck or bigger bucks for the bang: The fallacy of the cost-effectiveness threshold. J Health Serv Res Policy. 2006;11:4651.CrossRefGoogle ScholarPubMed
Claxton, K, Martin, S, Soares, M, Rice, N, Spackman, E, Hinde, S et al. Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. Health Technol Assess. 2015;19:1503.CrossRefGoogle ScholarPubMed
Stadhouders, N, Koolman, X, van Dijk, C, Jeurissen, P, Adang, E. The marginal benefits of healthcare spending in the Netherlands: Estimating cost-effectiveness thresholds using a translog production function. Health Econ. 2019;28:1331–44.CrossRefGoogle ScholarPubMed
Gafni, A, Birch, S. Incremental cost-effectiveness ratios (ICERs): The silence of the lambda. Soc Sci Med. 2006;62:2091–100.CrossRefGoogle ScholarPubMed
Birch, S, Gafni, A. Information created to evade reality (ICER): Things we should not look to for answers. Pharmacoeconomics. 2006;24:1121–31.CrossRefGoogle Scholar
Cleemput, I, Neyt, M, Thiry, N, De Laet, C, Leys, M. Using threshold values for cost per quality-adjusted life-year gained in healthcare decisions. Int J Technol Assess Health Care. 2012;27:71–6.CrossRefGoogle Scholar
Bobinac, A, van Exel, NJ, Rutten, FF, Brouwer, WB. Inquiry into the relationship between equity weights and the value of the QALY. Value Health. 2012;15:1119–26.CrossRefGoogle ScholarPubMed
Baltussen, R, Niessen, L. Priority setting of health interventions: The need for multi-criteria decision analysis. Cost Eff Resour Alloc. 2006;4:14.Google ScholarPubMed
Baltussen, R, Marsh, K, Thokala, P, Diaby, V, Castro, H, Cleemput, I et al. Multicriteria decision analysis to support HTA agencies: Benefits, limitations, and the way forward. Value Health. 2019;22:1283–88.CrossRefGoogle ScholarPubMed
Baltussen, R, Mikkelsen, E, Tromp, N, Hurtig, A, Byskov, J, Olsen, O et al. Balancing efficiency, equity and feasibility of HIV treatment in South Africa—Development of programmatic guidance. Cost Eff Resour Alloc. 2013;11:26.CrossRefGoogle ScholarPubMed
Mitton, C, Donaldson, C. Health care priority setting: Principles, practice and challenges. Cost Eff Resour Alloc. 2004;2:3.CrossRefGoogle ScholarPubMed
Youngkong, S, Teerawattananon, Y, Tantivess, S, Baltussen, R. Multi-criteria decision analysis for setting priorities on HIV/AIDS interventions in Thailand. Health Res Policy Syst. 2010;10:6.CrossRefGoogle Scholar
Angelis, A, Kanavos, P. Multiple criteria decision analysis (MCDA) for evaluating new medicines in health technology assessment and beyond: The advance value framework. Soc Sci Med. 2017;188:137–56.CrossRefGoogle ScholarPubMed
Morton, A. Treacle and smallpox: Two tests for multicriteria decision analysis models in health technology assessment. Value Health. 2017;20:512–15.CrossRefGoogle ScholarPubMed
Kolasa, K, Zwolinski, KM, Kalo, Z, Hermanowski, T. Potential impact of the implementation of multiple-criteria decision analysis (MCDA) on the Polish pricing and reimbursement process of orphan drugs. Orphanet J Rare Dis. 2016;11:23.CrossRefGoogle ScholarPubMed
Baltussen, R, Jansen, MPM, Bijlmakers, L, Grutters, J, Kluytmans, A, Reuzel, RP et al. Value assessment frameworks for HTA agencies: The organization of evidence-informed deliberative processes. Value Health. 2017;20:256–60.CrossRefGoogle ScholarPubMed
Government of Quebec. [Internet] Institut national d'excellence en sante et en services sociaux: Evaluation Process and Criteria [cited 2020 Mar 27]. Available from: https://www.inesss.qc.ca/en/themes/medicaments/drug-products/evaluation-process-and-criteria.html#c3510.Google Scholar
Jimenéz, A, Ais, A, Beaudet, A, Gil, A. Determining the value contribution of selexipag for the treatment of pulmonary arterial hypertension (PAH) in Spain using reflective multi-criteria decision analysis (MCDA). Orphanet J Rare Dis. 2018;13:220.CrossRefGoogle Scholar
Allen, N, Walker, SR, Liberti, L, Salek, S. Health technology assessment (HTA) case studies: Factors influencing divergent HTA reimbursement recommendations in Australia, Canada, England, and Scotland. Value Health. 2017;20:320–28.CrossRefGoogle ScholarPubMed
Kelley, L, Egan, R, Stockley, D, Johnson, AP. Evaluating multi-criteria decision-making in health technology assessment. Health Policy Technol. 2018;7:310–17.CrossRefGoogle Scholar