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Xue C, Du Y, Yang H, Jin H, Zhao Y, Ren B, Dong Z. Evaluating vonoprazan and tegoprazan for gastroesophageal reflux disease treatment in Chinese Healthcare: an EVIDEM framework analysis. BMC Gastroenterol 2024; 24:208. [PMID: 38902604 DOI: 10.1186/s12876-024-03297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND In Chinese healthcare settings, drug selection decisions are predominantly influenced by the Pharmacy & Therapeutics Committee (PTC). This study evaluates two recently introduced potassium-competitive acid blockers, vonoprazan (VPZ) and tegoprazan (TPZ), utilizing the Evidence and Value: Impact on DEcisionMaking (EVIDEM) framework. METHODS The study employed the 10th edition of EVIDEM, which includes a core model with five domains and 13 criteria. Two independent expert panels were involved: the PTC expert panel, tasked with assigning weights using a 5-point scale, defining scoring indicators, examining the evidence matrix, scoring, and decision-making; and the evidence matrix expert panel, responsible for conducting a systematic literature review, creating the evidence matrix, and evaluating the value contributions of VPZ and TPZ. RESULTS The analysis estimated the value contributions of VPZ and TPZ to be 0.59 and 0.54, respectively. The domain of 'economic consequences of intervention' showed the most significant variation in value contribution between the two drugs, followed by 'comparative outcomes of intervention' and 'type of benefit of intervention'. CONCLUSION Employing the EVIDEM framework, VPZ's value contribution was found to be marginally superior to that of TPZ. The EVIDEM framework demonstrates potential for broader application in Chinese medical institutions.
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Affiliation(s)
- Chaojun Xue
- Hebei General Hospital, Shijiazhuang, Hebei Province, China
- Hebei Key Laboratory of Clinical Pharmacy, Shijiazhuang, Hebei Province, China
| | - Yuhan Du
- Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Haotian Yang
- Hebei General Hospital, Shijiazhuang, Hebei Province, China
- Hebei Key Laboratory of Clinical Pharmacy, Shijiazhuang, Hebei Province, China
| | - Huixin Jin
- Hebei General Hospital, Shijiazhuang, Hebei Province, China
- Hebei Key Laboratory of Clinical Pharmacy, Shijiazhuang, Hebei Province, China
| | - Yue Zhao
- Hebei General Hospital, Shijiazhuang, Hebei Province, China
- Hebei Key Laboratory of Clinical Pharmacy, Shijiazhuang, Hebei Province, China
| | - Bingnan Ren
- Hebei General Hospital, Shijiazhuang, Hebei Province, China
- Hebei Key Laboratory of Clinical Pharmacy, Shijiazhuang, Hebei Province, China
| | - Zhanjun Dong
- Hebei General Hospital, Shijiazhuang, Hebei Province, China.
- Hebei Key Laboratory of Clinical Pharmacy, Shijiazhuang, Hebei Province, China.
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Su P, Zhi K, Xu H, Xiao J, Liu J, Wang Z, Liu Q, Yu Y, Dang H. The application of multi-criteria decision analysis in evaluating the value of drug-oriented intervention: a literature review. Front Pharmacol 2024; 15:1245825. [PMID: 38720775 PMCID: PMC11076741 DOI: 10.3389/fphar.2024.1245825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives: Multi-Criteria Decision Analysis (MCDA) has gained increasing attention in supporting drug risk-benefit assessment, pricing and reimbursement, as well as optimization of clinical interventions. The objective of this study was to systematically collect and categorize evaluation criteria and techniques of weighting and scoring of MCDA for drug value assessment. Methods: A systematic review of the literature was conducted across seven databases to identify articles utilizing the MCDA frameworks for the evaluation of drug value. Evaluation criteria mentioned in the included studies were extracted and assigned to 5 dimensions including clinical, economic, innovative, societal and humanistic value. A descriptive statistical analysis was performed on the identified drug value evaluation criteria, as well as the weighting and scoring techniques employed. The more a criterion or technique were mentioned in articles, the more important we consider it. Results: Out of the 82 articles included, 111 unique criteria were identified to evaluate the value of drug. Among the 56 unique criteria (448 times) used to measure clinical value, the most frequently mentioned were "comparative safety/tolerability" (58 times), "comparative effectiveness/efficacy" (56 times), "comparative patient-perceived health/patient reported outcomes" (37 times), "disease severity" (34 times), and "unmet needs" (25 times). Regarding economic value measurement, out of the 20 unique criteria (124 times), the most frequently utilized criteria were "cost of intervention" (17 times), "comparative other medical costs" (16 times), and "comparative non-medical costs" (18 times). Out of the 10 criteria (18 times) for assessing innovative value, "a novel pharmacological mechanism" was the most frequently mentioned criterion (5 times). Among the 22 criteria (73 times) used to measure societal value, "system capacity and appropriate use of intervention" was the most frequently cited criterion (14 times). Out of the 3 criteria (15 times) utilized to measure humanistic value, "political/historical/cultural context" was the most frequently mentioned criterion (9 times). Furthermore, 11 scoring and 11 weighting techniques were found from various MCDA frameworks. "Swing weighting" and "a direct rating scale" were the most frequently used techniques in included articles. Conclusion: This study comprehensively presented the current evaluation dimensions, criteria, and techniques for scoring and weighting in drug-oriented MCDA articles. By highlighting the frequently cited evaluation criteria and techniques for scoring and weighting, this analysis will provide a foundation to reasonably select appropriate evaluation criteria and technique in constructing the MCDA framework that aligns with research objectives.
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Affiliation(s)
- Pengli Su
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kai Zhi
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Huanhuan Xu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jing Xiao
- School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Jun Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhong Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiong Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanan Yu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Haixia Dang
- China Academy of Chinese Medical Sciences, Beijing, China
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Monreal E, Ruiz PD, San Román IL, Rodríguez-Antigüedad A, Moya-Molina MÁ, Álvarez A, García-Arcelay E, Maurino J, Shepherd J, Cabrera ÁP, Villar LM. Value contribution of blood-based neurofilament light chain as a biomarker in multiple sclerosis using multi-criteria decision analysis. Front Public Health 2024; 12:1397845. [PMID: 38711771 PMCID: PMC11073490 DOI: 10.3389/fpubh.2024.1397845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease that represents a leading cause of non-traumatic disability among young and middle-aged adults. MS is characterized by neurodegeneration caused by axonal injury. Current clinical and radiological markers often lack the sensitivity and specificity required to detect inflammatory activity and neurodegeneration, highlighting the need for better approaches. After neuronal injury, neurofilament light chains (NfL) are released into the cerebrospinal fluid, and eventually into blood. Thus, blood-based NfL could be used as a potential biomarker for inflammatory activity, neurodegeneration, and treatment response in MS. The objective of this study was to determine the value contribution of blood-based NfL as a biomarker in MS in Spain using the Multi-Criteria Decision Analysis (MCDA) methodology. Materials and methods A literature review was performed, and the results were synthesized in the evidence matrix following the criteria included in the MCDA framework. The study was conducted by a multidisciplinary group of six experts. Participants were trained in MCDA and scored the evidence matrix. Results were analyzed and discussed in a group meeting through reflective MCDA discussion methodology. Results MS was considered a severe condition as it is associated with significant disability. There are unmet needs in MS as a disease, but also in terms of biomarkers since no blood biomarker is available in clinical practice to determine disease activity, prognostic assessment, and response to treatment. The results of the present study suggest that quantification of blood-based NfL may represent a safe option to determine inflammation, neurodegeneration, and response to treatments in clinical practice, as well as to complement data to improve the sensitivity of the diagnosis. Participants considered that blood-based NfL could result in a lower use of expensive tests such as magnetic resonance imaging scans and could provide cost-savings by avoiding ineffective treatments. Lower indirect costs could also be expected due to a lower impact of disability consequences. Overall, blood-based NfL measurement is supported by high-quality evidence. Conclusion Based on MCDA methodology and the experience of a multidisciplinary group of six stakeholders, blood-based NfL measurement might represent a high-value-option for the management of MS in Spain.
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Affiliation(s)
- Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Red Española de Esclerosis Múltiple, Red de Enfermedades Inflamatorias, Universidad de Alcalá, Madrid, Spain
| | - Pilar Díaz Ruiz
- Department of Pharmacy, Hospital Nuestra Señora de Candelaria, Tenerife, Spain
| | | | | | | | | | | | | | | | | | - Luisa María Villar
- Department of Immunology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Asuquo DE, Attai KF, Johnson EA, Obot OU, Adeoye OS, Akwaowo CD, Ekpenyong N, Isiguzo C, Ekanem U, Motilewa O, Dan E, Umoh E, Ekpin V, Uzoka FME. Multi-criteria decision analysis method for differential diagnosis of tropical febrile diseases. Health Informatics J 2024; 30:14604582241260659. [PMID: 38860564 DOI: 10.1177/14604582241260659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
This paper employs the Analytical Hierarchy Process (AHP) to enhance the accuracy of differential diagnosis for febrile diseases, particularly prevalent in tropical regions where misdiagnosis may have severe consequences. The migration of health workers from developing countries has resulted in frontline health workers (FHWs) using inadequate protocols for the diagnosis of complex health conditions. The study introduces an innovative AHP-based Medical Decision Support System (MDSS) incorporating disease risk factors derived from physicians' experiential knowledge to address this challenge. The system's aggregate diagnostic factor index determines the likelihood of febrile illnesses. Compared to existing literature, AHP models with risk factors demonstrate superior prediction accuracy, closely aligning with physicians' suspected diagnoses. The model's accuracy ranges from 85.4% to 96.9% for various diseases, surpassing physicians' predictions for Lassa, Dengue, and Yellow Fevers. The MDSS is recommended for use by FHWs in communities lacking medical experts, facilitating timely and precise diagnoses, efficient application of diagnostic test kits, and reducing overhead expenses for administrators.
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Affiliation(s)
- Daniel E Asuquo
- Department of Information Systems, Faculty of Computing, University of Uyo, Uyo, Nigeria
| | - Kingsley F Attai
- Department of Mathematics & Computer Science, Ritman University, Ikot Ekpene, Nigeria
| | - Ekemini A Johnson
- Department of Mathematics & Computer Science, Ritman University, Ikot Ekpene, Nigeria
| | - Okure U Obot
- Department of Software Engineering, Faculty of Computing, University of Uyo, Uyo, Nigeria
| | - Olufemi S Adeoye
- Department of Data Science, Faculty of Computing, University of Uyo, Uyo, Nigeria
| | - Christie Divine Akwaowo
- Community Medicine Department, University of Uyo, Uyo, Nigeria
- Health Systems Research Hub, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Nnette Ekpenyong
- Community Health Department, University of Calabar, Calabar, Nigeria
| | | | - Uwemedimbuk Ekanem
- Community Medicine Department, University of Uyo, Uyo, Nigeria
- Institute of Health Research and Development, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Olugbemi Motilewa
- Community Medicine Department, University of Uyo, Uyo, Nigeria
- Health Systems Research Hub, University of Uyo Teaching Hospital, Uyo, Nigeria
- Institute of Health Research and Development, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Emem Dan
- Health Systems Research Hub, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Edidiong Umoh
- Health Systems Research Hub, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Victory Ekpin
- Health Systems Research Hub, University of Uyo Teaching Hospital, Uyo, Nigeria
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Bayón-Yusta JC, Gutiérrez-Iglesias A, Galnares-Cordero L, Gutiérrez-Ibarluzea I. Synthesis of relevant information around non-core domains to support Multi-Criteria Decision Analysis (MCDA) for decision making. GMS HEALTH INNOVATION AND TECHNOLOGIES 2024; 18:Doc02. [PMID: 38655192 PMCID: PMC11035910 DOI: 10.3205/hta000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Countries fundamentally base macro and micro decision making in the field of health on economic considerations, the budgetary impact of technologies being a major criterion. Nevertheless, the value of the technology of interest and its dimensions are more complex if we seek to take decisions based on the value itself. The use of structured and explicit approaches that require the assessment of multiple criteria that reflect the dimensions of this value may significantly improve the quality of the decision making. Multi-criteria decision analysis (MCDA) is a complementary decision-making tool that is able to systematically incorporate dimensions or domains such as ethical, organisational, legal, environmental and social considerations, as well as costs and benefits of medical interventions, together with the distinct perspectives of the interested parties. The objective of this article is to propose the implementation of analysis of non-core domains, in reports of Health Technology Assessment (HTA) agencies/units. To assess the scientific evidence on MCDA techniques a systematic review was conducted using structured searches in biomedical databases and websites of various HTA organisations. A consensus group was held using the nominal group technique and involving users of healthcare services, providers, managers and academics. Complementary, a survey was sent to HTA agencies to ascertain the degree of implementation of MCDA in their methods. 42 articles reporting the use of non-core criteria for the assessment of health technologies were included in the analysis. From these articles, a total of 216 non-core criteria were retrieved and categorised into domains by the researchers, and of these, 56 were classified as socioeconomic, 59 as organisational, 10 as legal, 8 as environmental and 47 as ethical, while 36 were considered to relate to other domains. The consensus group, based on the 216 non-core criteria obtained from the systematic review, proposed, and defined 26 criteria that participants considered necessary for decision making in healthcare. The consensus group did not consider that any of the domains should be given more weight than others or that any individual criteria should dominate. These approaches can serve as a framework of reference for a well-structured systematic discussion concerning the basis of individual criteria and the evidence supporting them.
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Affiliation(s)
- Juan Carlos Bayón-Yusta
- Basque Foundation for Health Innovation and Research (BIOEF), Barakaldo, Spain
- Osteba, Basque Office for HTA, Barakaldo, Spain
| | - Asun Gutiérrez-Iglesias
- Osteba, Basque Office for HTA, Barakaldo, Spain
- Ministry for Health, Basque Government, Vitoria-Gasteiz, Spain
| | - Lorea Galnares-Cordero
- Basque Foundation for Health Innovation and Research (BIOEF), Barakaldo, Spain
- Osteba, Basque Office for HTA, Barakaldo, Spain
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Abad MR, Alerany C, Alsina L, Granados EL, Neth O, Poveda JL, Rivière JG, Rodríguez-Gallego C, Tutein Nolthenius JB, Figueiredo R, Labazuy SS, Gil A. Determining value in the treatment of activated PI3Kδ syndrome in Spain: a multicriteria decision analysis from the perspective of key stakeholders. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:124-130. [PMID: 38784663 PMCID: PMC11113520 DOI: 10.33393/grhta.2024.3041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Activated phosphoinositide 3-kinase (PI3K)δ syndrome (APDS) is an ultra-rare inborn error of immunity (IEI) combining immunodeficiency and immune dysregulation. This study determined what represents value in APDS in Spain from a multidisciplinary perspective applying multicriteria decision analysis (MCDA) methodology. Methods A multidisciplinary committee of nine experts scored the evidence matrix. A specific framework for orphan drug evaluation in Spain and the weights assigned by a panel of 98 evaluators and decision-makers was used. Re-evaluation of scores was performed. Results APDS is considered a very severe disease with important unmet needs, including misdiagnosis and diagnostic delay. Current management is limited to treatment of symptoms with off-label use of therapies supported by limited evidence. Therapeutic benefit is partial, resulting in limited disease control. Haematopoietic stem cell transplantation (HSCT), the only potential curative alternative, is restricted to a reduced patient population and without evidence of long-term efficacy or safety. All options present a limited safety profile. Data on patients' quality of life are lacking. APDS is associated with high pharmacological, medical and indirect costs. Conclusions APDS is considered a severe disease, with limited understanding by key stakeholders of how treatment success is assessed in clinical practice, the serious impact that has on patients and the associated high economic burden. This study brings to light how MCDA methodology could represent a useful tool to complement current clinical and decision-making methods used by APDS experts and evaluators.
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Affiliation(s)
| | - Carmen Alerany
- Pharmacy Department, H.U. Vall d’ Hebron, Barcelona - Spain
| | - Laia Alsina
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, H. Sant Joan de Déu. Institut de Recerca Sant Joan de Déu. Universitat de Barcelona, Barcelona - Spain
| | | | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit H.U. Virgen del Rocío, Seville - Spain
| | | | - Jacques G. Rivière
- Paediatric Infectious Diseases and Immunodeficiencies Unit, H.U. Vall d’Hebron University Hospital, Barcelona - Spain
- Infection and Immunity in Pediatric Patients Research Group, Vall d’Hebron Institut de Recerca (VHIR), H.U. Vall d’Hebron, Barcelona - Spain
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Medical University of South Carolina, Barcelona - Spain
| | - Carlos Rodríguez-Gallego
- Department of Immunology, H.U. of Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Gran Canaria - Spain
| | | | | | | | - Alicia Gil
- Omakase Consulting S.L., Barcelona - Spain
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Caro Martínez A, Valcárcel Cabrera MDC, Olry de Labry Lima A. Value of concerted and hospital hemodialysis through a multi-criteria decision analysis. Nefrologia 2023; 43:742-749. [PMID: 38246811 DOI: 10.1016/j.nefroe.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/21/2022] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE To evaluate the value of the provision of contracted versus hospital dialysis services for the treatment of chronic kidney disease in Spain using the multicriteria decision analysis methodology. METHOD The EVIDEM (Evidence and Value: Impact on Decision Making) evaluation framework was used to calculate the estimated value of both dialysis delivery models (arranged vs. hospital) through a virtual workshop in which different profiles participated: directors and managers, professionals and heads of units and representatives of patients and relatives. The scores were combined using an additive lineal model, which combined the weight of the model with the individual score of the criteria, and each value was transformed to a scale between 0 and 1. RESULTS The estimated value for arranged dialysis was 0.29 (DS: ±0.2) and 0.39 (DS: ±0.2) for hospital dialysis. All profiles gave a higher value to hospital hemodialysis compared to contracted hemodialysis. The highest value for hospital dialysis was for patients (0.44), with the lowest mean value for directors (0.36) and the range for arranged dialysis being between patients (0.31) and intermediate positions (0.27). CONCLUSIONS Hospital hemodialysis obtained a higher value than concerted dialysis. In general, the panelists affirmed that it is a useful and interesting exercise and that, to a certain extent, it provides security in decision-making, since it allows ordering, rationalizing and considering, in an explicit and transparent manner, the different criteria involved.
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Affiliation(s)
- Araceli Caro Martínez
- Escuela Andaluza de Salud Pública, Granada, Spain; Programa de Doctorado Interuniversitario en Ciencias de la Salud, Universidad de Jaén-Universidad de Sevilla (UJA-US), Sevilla, Spain
| | | | - Antonio Olry de Labry Lima
- Centro Andaluz de Documentación e Información de Medicamentos (CADIME), Escuela Andaluza de Salud Pública, Granada, Spain; Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, CIBERESP; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
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Mathy C, Pascal C, Bongiovanni-Delarozière I, Favez L. Proposing a health-specific organizational impact framework to evaluate organizational impacts in health technology assessments. Int J Technol Assess Health Care 2023; 39:e60. [PMID: 37818664 DOI: 10.1017/s0266462323000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
OBJECTIVES Health technology assessments (HTAs) have traditionally included clinical and cost-effectiveness evaluation of new health technologies (HTs). However, new HTs can generate important organizational impacts (OIs) that influence their overall value. OIs are currently not clearly identified and evaluated in HTA procedures and tools are limited. To address this issue, a comprehensive framework that allows to assess OIs of new HTs in HTAs is proposed. METHODS A working and methodological group identified the Oslo Manual 2018, 4th edition, OECD/Eurostat, on the objectives and outcomes of commercial innovations as the basis for the OIs framework for HTAs. The Oslo Manual was translated to the healthcare sector and adapted to HTA procedures through a three-step process. RESULTS The framework is composed of three main parts. Part I tackles the context of the evaluation, Part II the categories of impacts and the specific impacts - in total, 16 OIs were identified - and Part III the stakeholders involved. The central part of the framework is Part II, and consists of three categories of impacts: (i) on the care process, (ii) on the stakeholders' capabilities and skills, and (iii) on society or the community. CONCLUSIONS This framework provides a comprehensive and structured basis to document OIs of new HTs. It thus contributes to the extension of HTA evaluation criteria to other dimensions than clinical and economic aspects, that is, organizational aspects. Some of its intrinsic limitations and the questions they raise in the field for policy-makers, practitioners, and researchers are discussed.
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Affiliation(s)
- Caryn Mathy
- School of Engineering and Management Vaud, HES-SO University of Applied Sciences and Arts Western Switzerland, Yverdon-les-Bains, Switzerland
| | | | | | - Lauriane Favez
- School of Engineering and Management Vaud, HES-SO University of Applied Sciences and Arts Western Switzerland, Yverdon-les-Bains, Switzerland
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Falip M, López González FJ, Martín-Herranz I, Merino-Bohórquez V, Montoya J, Rey Gómez-Serranillos I, Rodriguez Uranga JJ, Ruiz E, Sancho-López A, Trillo Mata JL, Antoni Vallès J, Álvarez-Barón E, Sabaniego J, Subías-Labazuy S, Gil A. Value contribution of cenobamate for the treatment of Focal-Onset Seizures (FOS) in patients with drug-resistant epilepsy (DRE) in Spain through reflective Multi-Criteria Decision Analysis (MCDA). Epilepsy Behav 2023; 145:109350. [PMID: 37480633 DOI: 10.1016/j.yebeh.2023.109350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Epilepsy is one of the most common neurological conditions worldwide. The main goal of its treatment is to achieve seizure freedom without intolerable adverse effects. However, despite the availability of many anti-seizure medications, including the latest options, called third-generation anti-seizure medications (ASMs), approximately 40% of people with epilepsy present drug-resistant epilepsy (DRE). Cenobamate is the first ASM approved in Spain for the adjunctive treatment of Focal-Onset Seizures (FOS) in adult patients with DRE. In a chronic disease with a portfolio of available ASMs, the decision to introduce a new therapeutic alternative must follow a holistic evaluation of value provided. Reflective Multi-Criteria Decision Analysis (MCDA) methodology allows to determine the value contribution of a treatment in a given indication considering all relevant criteria for healthcare decision-making in a transparent and systematic manner from the perspective of relevant stakeholders. PURPOSE The aim of this study was to determine the relative value contribution of cenobamate in the treatment of FOS in patients with DRE compared with third-generation ASMs using reflective MCDA-based methodology. METHODS A systematic literature review (combining biomedical databases and grey literature sources) was performed to populate the Evidence and Value: Impact on DEcisionMaking (EVIDEM) MCDA framework adapted to determine what represents value in the management of FOS in patients with DRE in Spain. The study was conducted in two phases. The first took place in 2021 with a multi-stakeholder group of eight participants. The second phase was conducted in 2022 with a multi-stakeholder group of 32 participants. Participants were trained in MCDA methodology and scored four evidence matrices (cenobamate vs. brivaracetam, vs. perampanel, vs. lacosamide and vs. eslicarbazepine acetate). Results were analyzed and discussed in a group meeting through reflective MCDA discussion methodology. RESULTS DRE is considered a very severe condition associated with many important unmet needs, mainly with regard to the lack of more effective treatments to achieve the ultimate goal of treatment. Compared to third-generation ASMs, cenobamate is perceived to have a better efficacy profile based on improvements in responder rate and seizure freedom. Regarding safety, it is considered to have a similar profile to alternatives and a positive quality-of-life profile. Cenobamate results in lower direct medical costs (excluding pharmacological) and indirect costs. Overall, cenobamate is regarded as providing a high therapeutic impact and supported by high-quality evidence. CONCLUSIONS Based on reflective MCDA methodology and stakeholders' experience in clinical management of epilepsy in Spain, cenobamate is perceived as a value-added option for the treatment of patients with DRE when compared with third-generation ASMs.
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Affiliation(s)
| | | | | | | | - Javier Montoya
- Hospital General Universitario de Valencia, Comunidad Valenciana, Spain
| | | | | | - Elías Ruiz
- Hospital General Universitario de Valencia, Comunidad Valenciana, Spain
| | | | | | | | | | | | | | - Alicia Gil
- Omakase Consulting S.L., Barcelona, Spain.
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Lahariya C, Sahoo KC, Sundararaman T, Prinja S, Rajsekhar K, Pati S. Universal health coverage in India and health technology assessment: current status and the way forward. Front Public Health 2023; 11:1187567. [PMID: 37333525 PMCID: PMC10272558 DOI: 10.3389/fpubh.2023.1187567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
In India, there is a renewed emphasis on Universal Health Coverage (UHC). Alongside this, Health Technology Assessment (HTA) is an important tool for advancing UHC. The development and application of HTA in India, including capacity building and establishing institutional mechanisms. We emphasized using the HTA approach within two components of the Ayushman Bharat programme, and the section concludes with lessons learned and the next steps. The UHC has increased the importance of selecting and implementing effective technologies and interventions within national health systems, particularly in the context of limited resources. To maximize the use of limited resources and produce reliable scientific assessments, developing and enhancing national capacity must be based on established best practices, information exchange between different sectors, and collaborative approaches. A more potent mechanism and capacity for HTA in India would accelerate the country's progress toward UHC.
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Affiliation(s)
- Chandrakant Lahariya
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People-centric Health Systems, New Delhi, India
- SD Gupta School of Public Health, The IIHMR University, Jaipur, India
| | - Krushna Chandra Sahoo
- Health Technology Assessment in India, Regional Resource Hub, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - T. Sundararaman
- Former Dean, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kavitha Rajsekhar
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Sanghamitra Pati
- Health Technology Assessment in India, Regional Resource Hub, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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11
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Ahumada-Canale A, Jeet V, Bilgrami A, Seil E, Gu Y, Cutler H. Barriers and facilitators to implementing priority setting and resource allocation tools in hospital decisions: A systematic review. Soc Sci Med 2023; 322:115790. [PMID: 36913838 DOI: 10.1016/j.socscimed.2023.115790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/24/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Health care budgets in high-income countries are having issues coping with unsustainable growth in demand, particularly in the hospital setting. Despite this, implementing tools systematising priority setting and resource allocation decisions has been challenging. This study answers two questions: (1) what are the barriers and facilitators to implementing priority setting tools in the hospital setting of high-income countries? and (2) what is their fidelity? A systematic review using the Cochrane methods was conducted including studies of hospital-related priority setting tools reporting barriers or facilitators for implementation, published after the year 2000. Barriers and facilitators were classified using the Consolidated Framework for Implementation Research (CFIR). Fidelity was assessed using priority setting tool's standards. Out of thirty studies, ten reported program budgeting and marginal analysis (PBMA), twelve multi-criteria decision analysis (MCDA), six health technology assessment (HTA) related frameworks, and two, an ad hoc tool. Barriers and facilitators were outlined across all CFIR domains. Implementation factors not frequently observed, such as 'evidence of previous successful tool application', 'knowledge and beliefs about the intervention' or 'external policy and incentives' were reported. Conversely, some constructs did not yield any barrier or facilitator including 'intervention source' or 'peer pressure'. PBMA studies satisfied the fidelity criteria between 86% and 100%, for MCDA it varied between 36% and 100%, and for HTA it was between 27% and 80%. However, fidelity was not related to implementation. This study is the first to use an implementation science approach. Results represent the starting point for organisations wishing to use priority setting tools in the hospital setting by providing an overview of barriers and facilitators. These factors can be used to assess readiness for implementation or to serve as the foundation for process evaluations. Through our findings, we aim to improve the uptake of priority setting tools and support their sustainable use.
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Affiliation(s)
- Antonio Ahumada-Canale
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Varinder Jeet
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Anam Bilgrami
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Elizabeth Seil
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Henry Cutler
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
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Hamad A, Elazzazy S, Bujassoum S, Rasul K, Gaziev J, Cherif H, Al-Boloshi Z, Hanssens Y, Saleh A, Rasheed HA, Al-Badriyeh D, Babiker A, Hmaidan AA, Al-Hail M. Applying value-based strategies to accelerate access to novel cancer medications: guidance from the Oncology Health Economics Expert Panel in Qatar (Q-OHEP). BMC Health Serv Res 2023; 23:15. [PMID: 36609388 PMCID: PMC9816531 DOI: 10.1186/s12913-022-08981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/16/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In line with global trends, cancer incidence and mortality may have decreased for specific types of cancer in Qatar. However, the cancer-related burden on patients, healthcare systems, and the economy is expected to expand; thus, cancer remains a significant public healthcare issue in Qatar. Qatar's free access to cancer care represents a considerable economic burden. Ensuring the best utilization of financial resources in the healthcare sector is important to provide unified and fair access to cancer care for all patients. Experts from the Qatar Oncology Health Economics Expert Panel (Q-OHEP) aimed to establish a consistent and robust base for evaluating oncology/hematology medications; involve patients' insights to accelerate access to cutting-edge medications; increase the value of cancer care; and reach a consensus for using cost-effective strategies and efficient methodologies in cancer treatment. METHODS The Q-OHEP convened on 30 November 2021 for a 3-hour meeting to discuss cancer management, therapeutics, and health economics in Qatar, focusing on four domains: (1) regulatory, (2) procurement, (3) treatment, and (4) patients. Discussions, guided by a moderator, focused on a list of suggested open-ended questions. RESULTS Some of the salient recommendations included the development of a formal, fast-track, preliminary approval pathway for drugs needed by patients with severe disease or in critical condition; and encouraging and promoting the conduct of local clinical trials and real-world observational studies using existing registry data. The Q-OHEP also recommended implementing a forecast system using treatment center data based on the supply/demand of formulary oncology drugs to detect treatment patterns, estimate needs, expedite procurement, and prevent shortages/delays. Furthermore, the panel discussed the needs to define value concerning cancer treatment in Qatar, implement value-based models for reimbursement decision-making such as health technology assessment and multiple-criteria decision analysis, and promote patient education and involvement/feedback in developing and implementing cancer management guidelines. CONCLUSION Herein, we summarize the first Q-OHEP consensus recommendations, which aim to provide a solid basis for evaluating, registering, and approving new cancer medications to accelerate patient access to novel cancer treatments in Qatar; promote/facilitate the adoption and collection of patient-reported outcomes; and implement value-based cancer care in Qatar.
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Affiliation(s)
- Anas Hamad
- grid.413548.f0000 0004 0571 546XPharmacy Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Shereen Elazzazy
- grid.413548.f0000 0004 0571 546XPharmacy Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Salha Bujassoum
- grid.466917.b0000 0004 0637 4417Medical Oncology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Kakil Rasul
- grid.466917.b0000 0004 0637 4417Medical Oncology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Javid Gaziev
- grid.413548.f0000 0004 0571 546XHematology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Honar Cherif
- grid.413548.f0000 0004 0571 546XHematology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Zakiya Al-Boloshi
- grid.413548.f0000 0004 0571 546XDrug Supply Department, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Yolande Hanssens
- grid.413548.f0000 0004 0571 546XPharmacy Executive Office, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ayman Saleh
- grid.467063.00000 0004 0397 4222Division of Pediatric Hematology/Oncology, Sidra Medicine, PO Box 26999, Doha, Qatar
| | - Hadi Abu Rasheed
- Professional Development & Scientific Research Department, Qatar Cancer Society, PO Box 22944, Doha, Qatar
| | - Daoud Al-Badriyeh
- grid.412603.20000 0004 0634 1084College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Ahmed Babiker
- grid.498619.bRegistration & Drugs Pricing Section, Pharmacy & Drug Control Department, Ministry of Public Health, PO Box 42, Doha, Qatar
| | - Amid Abu Hmaidan
- grid.498619.bNational Cancer Program, Directorate of Policy, Ministry of Public Health, PO Box 42, Doha, Qatar
| | - Moza Al-Hail
- grid.413548.f0000 0004 0571 546XPharmacy Executive Office, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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13
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Domingo C, Fernandez M, Garin N, Milara J, Moran I, Muerza I, Pacheco A, Teruel C, Bentley R, Subiran R, Gil A. Determining What Represents Value in the Treatment of Refractory or Unexplained Chronic Cough from the Perspective of Key Stakeholders in Spain Using Multi-Criteria Decision Analysis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:119-130. [PMID: 36319945 PMCID: PMC9628572 DOI: 10.1007/s40258-022-00770-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Chronic cough is defined as cough lasting for more than 8 weeks. It can be described as refractory when persisting despite thorough clinical assessment and treatment of any cough-related underlying condition, or unexplained when no underlying cough-related condition can be identified. Refractory or unexplained chronic cough (RCC|UCC) greatly affects patient health-related quality of life (HRQoL). Although around 10% of the population suffer from chronic cough (with 40-60% of these patients suffering from RCC|UCC), there is limited information available in the literature about the condition and the assessment of treatment success. This study aimed to determine what represents value in the treatment of RCC|UCC from the perspective of key stakeholders in Spain using Multi-Criteria Decision Analysis (MCDA) methodology. METHODS A literature review was conducted to adapt the MCDA framework to the specific context of RCC|UCC. A total of 24 participants were involved, representing three key stakeholder groups (7 patients, 9 physicians and 8 hospital pharmacists). The study was structured in two phases. In Phase 1, participants validated the adapted MCDA framework and assigned relative weights (100-point allocation) to the framework's value criteria/sub-criteria during three individual stakeholder meetings, one per each stakeholder group. In Phase 2, participants were brought together in a multi-stakeholder meeting to review findings of each stakeholder group, after which stakeholders repeated the weighting exercise as a collective group. All meetings included reflective discussion by participants of each value criteria/sub-criteria included within the adapted MCDA framework, where stakeholders shared their perspectives and opinions on what represents value in RCC|UCC. RESULTS Refractory or unexplained chronic cough is regarded as a chronic medical condition, with variable severity across patients and the potential to heavily impact their HRQoL (including physical, psychological and social/work productivity domains). Current treatments used by healthcare professionals, which have not been specifically developed and are not approved for RCC|UCC, show limited clinical effectiveness and associated safety and tolerability issues, which result in frequent treatment discontinuations. The reduction of the average cough frequency over a 24-h period is regarded as the primary goal of treatment by stakeholders, with the aim of improving HRQoL. Improvement of other cough symptoms, such as intensity, is also considered important. Minor adverse events and a slower onset of treatment effect would be acceptable to stakeholders if accompanied by strong efficacy and improvement in HRQoL. Given the inability to measure cough frequency in clinical practice, Patient-Reported Outcomes (PROs) could be considered a proxy of treatment effectiveness. A multidisciplinary approach to the condition is regarded as key for treatment success. CONCLUSIONS Refractory or unexplained chronic cough is a medical condition that seriously impacts patients' HRQoL. The primary goal of treatment is to improve patients' HRQoL by reducing the frequency and intensity of cough.
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Affiliation(s)
- Christian Domingo
- Pulmonology Department, Hospital Parc Tauli, Sabadell, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mario Fernandez
- Otolaryngology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Noe Garin
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Milara
- Pharmacy Department, Hospital General de Valencia, Valencia, Spain
| | - Ignacio Moran
- Spanish Federation of Patient Organisations with Allergic and Respiratory Diseases (FENAER), Madrid, Spain
| | - Irantzu Muerza
- Spanish Federation of Patient Organisations with Allergic and Respiratory Diseases (FENAER), Madrid, Spain
| | | | - Carlos Teruel
- Gastroenterology Department, Hospital Ramon y Cajal, Madrid, Spain
| | - Roy Bentley
- Global Market Access, Shionogi Inc., New Jersey, USA
| | | | - Alicia Gil
- Omakase Consulting S.L., Barcelona, Spain.
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Dranitsaris G, Zhang Q, Quill A, Mu L, Weyrer C, Dysdale E, Neumann P, Tahami Monfared AA. Treatment Preference for Alzheimer's Disease: A Multicriteria Decision Analysis with Caregivers, Neurologists, and Payors. Neurol Ther 2022; 12:211-227. [PMID: 36422822 PMCID: PMC9837350 DOI: 10.1007/s40120-022-00423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Alzheimer's disease (AD) is a chronic neurodegenerative disorder associated with a high burden of illness. New therapies under development include agents that target amyloid-beta (Aβ), a key component in AD pathogenesis. Understanding the decision-making process for new AD drugs would help determine if such therapies should be adopted by society. Multicriteria decision analysis (MCDA) was applied to three key stakeholder groups to assess treatment alternatives for AD based on a multitude of decision trade-offs covering main components of care. METHODS AD caregivers (n = 117), neurologists (n = 90), and payors (n = 90) from the USA received an online survey. The decision problem was broken down into four decision criterion and 12 subcriteria for two treatment scenarios: an Aβ-targeted therapy vs. the standard of care (SOC). Respondents were asked to indicate how much they preferred one option over another on a scale from 1 (equal preference) to 9 (high preference) based on each criterion and subcriterion. The decision criteria and subcriteria were weighted and presented as partial utility scores (pUS), with higher scores suggesting an increased preference for that decision-making component. RESULTS Caregivers and payors applied the highest value to need for intervention (mean pUS = 0.303 and 0.259) and clinical outcomes (mean pUS = 0.286 and 0.377). In contrast, neurologists placed the highest value on clinical outcomes and types of benefits (mean pUS = 0.436 and 0.248). When decision subcriteria were examined, efficacy (mean pUS = 0.115, 0.219, and 0.166) and the type of patient benefits (mean pUS = 0.135, 0.178, and 0.126) were among the most valued by caregivers, neurologists, and payors. CONCLUSION All groups placed the highest value on drug efficacy and types of benefit derived by patients. In contrast, cost implications were among the least important aspects in their decision-making.
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Affiliation(s)
- George Dranitsaris
- Department of Public Health, Falk College, Syracuse University, 150 Crouse Dr, Syracuse, NY, 13244, USA.
| | | | | | - Lin Mu
- Boston Consulting Group, Boston, MA USA
| | | | | | - Peter Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA USA
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15
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Hoedemakers M, Tsiachristas A, Rutten-van Mölken M. Moving Beyond Quality-Adjusted Life-Years in Elderly Care: How Can Multicriteria Decision Analysis Complement Cost-Effectiveness Analysis in Local-Level Decision Making. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1717-1725. [PMID: 35623974 DOI: 10.1016/j.jval.2022.04.1728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/21/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to investigate how multicriteria decision analysis (MCDA) could complement cost-effectiveness analysis (CEA) to support investment decisions in elderly care at local level. METHODS We used an integrated elderly care program in The Netherlands as a case study to demonstrate the application of both methods. In a 12-month quasi-experimental study (n = 384), data on the following outcome measures were collected: quality-adjusted life-years (CEA) and physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person centeredness, continuity of care, and costs (MCDA). We performed regression analysis on inversed probability weighted data and controlled for potential confounders to obtain a double robust estimate of the outcomes. Probabilistic sensitivity analyses determined uncertainty for both methods. RESULTS The integrated elderly care program was not likely (ie, 36%) to be cost-effective according to the CEA (incremental cost-effectiveness ratios: €88 249 from a societal perspective) using the conventional Dutch willingness-to-pay threshold (ie, €50 000). The MCDA demonstrated that informal caregivers and professionals slightly preferred the intervention over usual care, driven by enjoyment of life and person centeredness. Patients did not prefer either the intervention or usual care, whereas payers and policy makers slightly preferred usual care, mainly due to higher costs of the intervention. CONCLUSIONS MCDA could provide local-level decision makers with a broader measurement of effectiveness by including outcomes beyond health and longevity and the preferences of multiple stakeholders. This additional information could foster the acceptability and implementability of cost-effective innovations in elderly care.
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Affiliation(s)
- Maaike Hoedemakers
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Caro Martínez A, Valcárcel Cabrera MDC, Olry de Labry Lima A. Valor de la hemodiálisis concertada y la hospitalaria mediante un análisis de decisión multicriterio. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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17
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Dai Z, Xu S, Wu X, Hu R, Li H, He H, Hu J, Liao X. Knowledge Mapping of Multicriteria Decision Analysis in Healthcare: A Bibliometric Analysis. Front Public Health 2022; 10:895552. [PMID: 35757629 PMCID: PMC9218106 DOI: 10.3389/fpubh.2022.895552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Multicriteria decision analysis (MCDA) is a useful tool in complex decision-making situations, and has been used in medical fields to evaluate treatment options and drug selection. This study aims to provide valuable insights into MCDA in healthcare through examining the research focus of existing studies, major fields, major applications, most productive authors and countries, and most common journals in the domain. Methods A bibliometric analysis was conducted on the publication related to MCDA in healthcare from the Web of Science Core Collection (WoSCC) database on 14 July 2021. Three bibliometric software (VOSviewer, R-bibliometrix, and CiteSpace) were used to conduct the analysis including years, countries, institutes, authors, journals, co-citation references, and keywords. Results A total of 410 publications were identified with an average yearly growth rate of 32% (1999–2021), from 196 academic journals with 23,637 co-citation references by 871 institutions from 70 countries/regions. The United States was the most productive country (n = 80). Universiti Pendidikan Sultan Idris (n = 16), Université de Montréal (n = 13), and Syreon Research Institute (n = 12) were the top productive institutions. A A Zaidan, Mireille Goetghebeur and Zoltan Kalo were the biggest nodes in every cluster of authors' networks. The top journals in terms of the number of articles (n = 17) and citations (n = 1,673) were Value in Health and Journal of Medical Systems, respectively. The extant literature has focused on four aspects, including the analytic hierarchy process (AHP), decision-making, health technology assessment, and healthcare waste management. COVID-19 and fuzzy TOPSIS received careful attention from MCDA applications recently. MCDA in big data, telemedicine, TOPSIS, and fuzzy AHP is well-developed and an important theme, which may be the trend in future research. Conclusion This study uncovers a holistic picture of the performance of MCDA-related literature published in healthcare. MCDA has a broad application on different topics and would be helpful for practitioners, researchers, and decision-makers working in healthcare to advance the wheel of medical complex decision-making. It can be argued that the door is still open for improving the role of MCDA in healthcare, whether in its methodology (e.g., fuzzy TOPSIS) or application (e.g., telemedicine).
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Affiliation(s)
- Zeqi Dai
- Center for Evidence-Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Simin Xu
- Center for Evidence-Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xue Wu
- Center for Evidence-Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ruixue Hu
- Center for Evidence-Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huimin Li
- Center for Evidence-Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Haoqiang He
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jing Hu
- Evidence-Based Medicine Center, Beijing Hospital of Traditional Chinese Medicine, Beijing Institute of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Xing Liao
- Center for Evidence-Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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Calleja MÁ, Badia X. Feasibility study to characterize price and reimbursement decision-making criteria for the inclusion of new drugs in the Spanish National Health System: the cefiderocol example. Int J Technol Assess Health Care 2022; 38:e48. [PMID: 35591781 DOI: 10.1017/s0266462322000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The reimbursement of medicines by the Spanish National Health System (NHS) is based on a set of criteria included in the Royal Legislative Decree 1/2015 (RDL 1/2015). The Interministerial Committee on Pricing of Medicines and Healthcare Products (CIPM) is responsible for the final price and reimbursement (P&R) decision, including on its resolutions the criteria listed in the law by which the reimbursement of a drug is approved or denied. Nevertheless, the information behind its reasoning is not provided. The present study aims to characterize the P&R criteria of the RDL 1/2015 through criteria definitions from other countries to improve the P&R evaluation in Spain. RESULTS A multidisciplinary experts panel with relevant experience in drug evaluation and decision making at national, regional, and local level in Spain was selected for this study. A literature review to characterize the criteria listed in the RDL 1/2015 was performed based on the most relevant and recognized Health Technology Assessment (HTA) agencies in Europe, UK, and Canada. Eventually, a feasibility study was performed to evaluate the novel drug cefiderocol using the characterized criteria, including a reflective discussion of the results. CONCLUSIONS Consensus was reached among the multidisciplinary experts on the characterization of the criteria set by the law. The feasibility of their application to a new drug was exploratory, notwithstanding it showed the potential to improve the transparency as well as to offer a more structured rationale for the CIPM to evaluate the inclusion of new drugs in the Spanish NHS.
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Gasol M, Paco N, Guarga L, Bosch JÀ, Pontes C, Obach M. Early Access to Medicines: Use of Multicriteria Decision Analysis (MCDA) as a Decision Tool in Catalonia (Spain). J Clin Med 2022; 11:jcm11051353. [PMID: 35268443 PMCID: PMC8910942 DOI: 10.3390/jcm11051353] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 01/13/2023] Open
Abstract
Early access to medicines allows the prescription of a medicine before it is available in the public formulary to patients with severe or rare diseases with high unmet needs who have no authorised therapeutic alternatives available. In this context, consistent decision making is difficult, and a systematic assessment procedure could be useful to tackle complex situations and guarantee the equity of medicines’ access. A multidisciplinary panel (MP) conducted four workshops to develop an early access framework based on a reflective multiple criteria decision analysis (MCDA). A set of 12 criteria was agreed: eight quantitative (severity of disease, urgency, efficacy, safety, internal and external validity, therapeutic benefit and plausibility) and four qualitative (therapeutic alternative, existence of precedents, management impact and costs). Quantitative criteria were weighted using a five-point scale. The relative importance of quantitative criteria had mean weights from 4.7 to 3.6, showing its relevance in the decisions. The framework was tested using two case studies, and reliability was assessed by re-test. The re-test revealed no statistical differences, indicating the consistency and replicability of the framework developed. MCDA may help to structure discussions for heterogeneous treatment requests, providing predictability and robustness in decision making involving sensitive and complex situations.
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Affiliation(s)
- Montse Gasol
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain;
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain; (N.P.); (L.G.); (M.O.)
- Digitalization for the Sustainability of the Healthcare System (DS3), Bellvitge Biomedical Research Institute (IDIBELL), 08006 Barcelona, Spain
| | - Noelia Paco
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain; (N.P.); (L.G.); (M.O.)
| | - Laura Guarga
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain; (N.P.); (L.G.); (M.O.)
| | - Josep Àngel Bosch
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain;
| | - Caridad Pontes
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain;
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain; (N.P.); (L.G.); (M.O.)
- Digitalization for the Sustainability of the Healthcare System (DS3), Bellvitge Biomedical Research Institute (IDIBELL), 08006 Barcelona, Spain
- Correspondence:
| | - Mercè Obach
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain; (N.P.); (L.G.); (M.O.)
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Talantsev A, Fasth T, Wenner C, Wolff E, Larsson A. Evaluation of pharmaceutical intervention strategies against pandemics in Sweden: A scenario‐driven multiple criteria decision analysis study. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2022. [DOI: 10.1002/mcda.1779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anton Talantsev
- Department of Computer and Systems Sciences Stockholm University Stockholm Sweden
| | - Tobias Fasth
- Department of Computer and Systems Sciences Stockholm University Stockholm Sweden
- Public Health Analysis and Data Management Public Health Agency of Sweden Solna Sweden
| | - Cenny Wenner
- Public Health Analysis and Data Management Public Health Agency of Sweden Solna Sweden
| | - Ellen Wolff
- Public Health Analysis and Data Management Public Health Agency of Sweden Solna Sweden
| | - Aron Larsson
- Department of Computer and Systems Sciences Stockholm University Stockholm Sweden
- Risk and Crisis Research Centre Mid Sweden University Sundsvall Sweden
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21
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A multicriteria decision analysis (MCDA) applied to three long-term prophylactic treatments for hereditary angioedema in Spain. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2022; 9:14-21. [PMID: 36628319 PMCID: PMC9768612 DOI: 10.33393/grhta.2022.2333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/15/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction Hereditary angioedema (HAE) is a rare genetic disease that impairs quality of life and could be life-threatening. The aim of this study was to apply a multicriteria decision analysis to assess the value of three long-term prophylactic (LTP) therapies for HAE in Spain. Methods A multidisciplinary committee of 10 experts assessed the value of lanadelumab (subcutaneous use), C1-inhibitor (C1-INH; intravenous), and danazol (orally), using placebo as comparator. We followed the EVIDEM methodology that considers a set of 13 quantitative criteria. The overall estimated value of each intervention was obtained combining the weighting of each criterion with the scoring of each intervention in each criterion. We used two alternative weighting methods: hierarchical point allocation (HPA) and direct rating scale (DRS). A reevaluation of weightings and scores was performed. Results Lanadelumab obtained higher mean scores than C1-INH and danazol in all criteria, except for the cost of the intervention and clinical practice guidelines. Under the HPA method, the estimated values were 0.51 (95% confidence interval [CI]: 0.44-0.58) for lanadelumab, 0.47 (95%CI: 0.41-0.53) for C1-INH, and 0.31 (95%CI: 0.24-0.39) for danazol. Similar results were obtained with the DRS method: 0.51 (95%CI: 0.42-0.60), 0.47 (95%CI: 0.40-0.54), and 0.27 (95%CI: 0.18-0.37), respectively. The comparative cost of the intervention was the only criterion that contributed negatively to the values of lanadelumab and C1-INH. For danazol, four criteria contributed negatively, mainly comparative safety. Conclusion Lanadelumab was assessed as a high-value intervention, better than C1-INH and substantially better than danazol for LTP treatment of HAE.
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Identifying key unmet needs and value drivers in the treatment of focal-onset seizures (FOS) in patients with drug-resistant epilepsy (DRE) in Spain through Multi-Criteria Decision Analysis (MCDA). Epilepsy Behav 2021; 122:108222. [PMID: 34371462 DOI: 10.1016/j.yebeh.2021.108222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Epilepsy is a serious neurological disease, ranking high in the top causes of disability. Approximately 40% of patients with epilepsy are pharmacoresistant after their seizures failed at least two antiseizure medications (ASMs). Adult patients experiencing focal-onset seizures (FOS) account for approximately 60% of all patients with epilepsy and they are more likely to become drug-resistant epilepsy (DRE) than those with generalized onset. Drug-resistant epilepsy is associated with mortality, morbidity, and reduced quality of life. The information available on the clinical management, health outcomes, and unmet needs of the disease within the Spanish healthcare environment is very limited. Multi-Criteria Decision Analysis (MCDA) allows determination of what represents value in a given indication considering all relevant criteria for healthcare decision-making in a transparent and systematic manner and from the perspective of relevant stakeholders. PURPOSE The aim of this study was to identify the burden of DRE (clinical, quality of life, and economic) and the unmet needs in Spain and to determine what represents value in the treatment of FOS in DRE patients from the perspective of Spanish epileptologists. METHODS The steps taken to carry out the MCDA were based on previously published good methodological practices. A systematic literature review (combining biomedical databases and gray literature sources) was performed between March and April 2020. Results were reviewed and validated with three epileptologists in June 2020 and used to develop a MCDA value framework, adapted for FOS in DRE, composed of 12 quantitative criteria and 3 contextual criteria. A group of six Spanish epileptologists from four Spanish regions were trained in MCDA methodology before individually validating value criteria (and their definitions based on literature review findings) and assigned relative weights using an ordinal 6-points scale. Results were analyzed and discussed in a group meeting through reflective MCDA discussion methodology. RESULTS Drug-resistant epilepsy is considered a very severe health problem with important unmet needs affecting a considerably sized population. While safety and impact on quality of life of available ASMs are considered adequate, efficacy remains insufficient for patients to achieve seizure freedom and maintain it over time. Hence, the therapeutic benefit of pharmacological treatments currently used is regarded as suboptimal. Drug-resistant epilepsy management is associated with moderate pharmacological, relevant direct medical and high indirect costs. Quality of evidence available for current treatments is moderate. It is considered that DRE does not currently stand as a key priority for the Spanish healthcare system. CONCLUSIONS Drug-resistant epilepsy is considered a very severe health problem associated with relevant unmet needs. These include the lack of availability of specific treatment protocols, the need to improve early diagnosis by increasing the number of referrals to specialized epilepsy units and the availability of specific ASMs with improved efficacy and safety profiles, allowing to reach treatment objectives. Reflective MCDA provided a standardized, transparent approach to evaluate multiple criteria ascertaining what represents value from a holistic point of view and from the perspective of clinical experts, facilitating decision-making.
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Yang C, Wang Y, Hu X, Chen Y, Qian L, Li F, Gu W, Liu Q, Wang D, Chai X. Improving Hospital Based Medical Procurement Decisions with Health Technology Assessment and Multi-Criteria Decision Analysis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211022911. [PMID: 34120491 PMCID: PMC8202291 DOI: 10.1177/00469580211022911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This research proposes a new medical procurement decision-making tool named Evaluation of Medical Technology Procurement (EMTP), which combines Mini-health Technology Assessment (Mini HTA) with the analytic hierarchy process (AHP), as well as the intuitionistic linguistic multi-criteria group decision model for multi-criteria decision analysis (MCDA). This tool was applied to a medical device procurement decision in a large provincial general hospital with more than 5000 beds in China as a case study. Specifically, the AHP evaluation framework is first established to determine the evaluation dimensions and criteria. This goal is achieved by applying the AdHopHTA Mini-HTA template and gathering data from questionnaires completed by experts from 33 major public hospitals in Anhui Province, China. The professionals within the application hospital were invited to evaluate the alternative products in a pairwise comparison and obtain a ranking of their advantages and disadvantages. This goal is achieved using the intuitionistic linguistic fuzzy model to deal with the subjectivity and uncertainty that may be present in the professional evaluation by experts in different fields. At the same time, the Keeney-Raiffa MCDA (KRM) method was used to demonstrate the accuracy of the application results. The results show that our tool can achieve the same effect as the verification method while being more efficient, easier to use, and requiring fewer participants. The advantages and disadvantages of several evaluation methods combined with multi-criteria methods are discussed, including verification methods, pointing out the advantages and limitations of this research tool as well as the prospects for the future.
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Affiliation(s)
- Chai Yang
- Hefei University of Technology, Hefei, P.R. China.,The First Affiliated Hospital of University of Sciences and Technology of China, Hefei, P.R. China
| | - Yanjun Wang
- Hefei University of Technology, Hefei, P.R. China
| | - Xiaoxuan Hu
- Hefei University of Technology, Hefei, P.R. China
| | - Yujun Chen
- The First Affiliated Hospital of University of Sciences and Technology of China, Hefei, P.R. China.,Anhui Provincial Medical Equipment Management and Quality Control Center, Hefei, Anhui, P.R. China
| | - Liting Qian
- The First Affiliated Hospital of University of Sciences and Technology of China, Hefei, P.R. China
| | - Fuchang Li
- Yunnan Normal University, Kunming, Yunnan, P.R. China
| | - Wei Gu
- The First Affiliated Hospital of University of Sciences and Technology of China, Hefei, P.R. China
| | - Qiang Liu
- China Pharmaceutical University, Nanjing, Jiangsu, P.R. China
| | - Di Wang
- The First Affiliated Hospital of University of Sciences and Technology of China, Hefei, P.R. China
| | - Xiaoqing Chai
- The First Affiliated Hospital of University of Sciences and Technology of China, Hefei, P.R. China.,Anhui Provincial Anesthesia Quality Control Center, Hefei, Anhui, P.R. China
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van den Bogaart EHA, Kroese MEAL, Spreeuwenberg MD, Ruwaard D, Tsiachristas A. Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:795-803. [PMID: 34119077 DOI: 10.1016/j.jval.2021.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/30/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To experiment with new approaches of collaboration in healthcare delivery, local authorities implement new models of care. Regarding the local decision context of these models, multi-criteria decision analysis (MCDA) may be of added value to cost-utility analysis (CUA), because it covers a wider range of outcomes. This study compares the 2 methods using a side-by-side application. METHODS A new Dutch model of care, Primary Care Plus (PC+), was used as a case study to compare the results of CUA and MCDA. Data of patients referred to PC+ or care-as-usual were retrieved by questionnaires and administrative databases with a 3-month follow-up. Propensity score matching together with generalized linear regression models was used to reduce confounding. Univariate and probabilistic sensitivity analyses were performed to explore uncertainty in the results. RESULTS Although both methods indicated PC+ as the dominant alternative, complementary differences were observed. MCDA provided additional evidence that PC+ improved access to care (standardized performance score of 0.742 vs 0.670) and that improvement in health-related quality of life was driven by the psychological well-being component (standardized performance score of 0.710 vs 0.704). Furthermore, MCDA estimated the budget required for PC+ to be affordable in addition to preferable (€521.42 per patient). Additionally, MCDA was less sensitive to the utility measures used. CONCLUSIONS MCDA may facilitate an auditable and transparent evaluation of new models of care by providing additional information on a wider range of outcomes and incorporating affordability. However, more effort is needed to increase the usability of MCDA among local decision makers.
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Affiliation(s)
- Esther H A van den Bogaart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marieke D Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Research Center for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Gardas BB, Ghongade NP, Jagtap AH. Application of multi‐criteria decision‐making approach in healthcare surgical management. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2021. [DOI: 10.1002/mcda.1753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Bhaskar B. Gardas
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
| | - Nilesh P. Ghongade
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
| | - Annasaheb H. Jagtap
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
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Glomsås HS, Knutsen IR, Fossum M, Halvorsen K. 'They just came with the medication dispenser'- a qualitative study of elderly service users' involvement and welfare technology in public home care services. BMC Health Serv Res 2021; 21:245. [PMID: 33740974 PMCID: PMC7977566 DOI: 10.1186/s12913-021-06243-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Public home care for the elderly is a key area in relation to improving health care quality. It is an important political goal to increase elderly people's involvement in their care and in the use of welfare technology. The aim of this study was to explore elderly service users' experience of user involvement in the implementation and everyday use of welfare technology in public home care services. METHOD This qualitative study has an explorative and descriptive design. Sixteen interviews of service users were conducted in five different municipalities over a period of six months. The data were analysed using reflexive thematic analysis. RESULTS Service users receiving public home care service are not a homogenous group, and the participants had different wishes and needs as regards user involvement and the use of welfare technology. The analysis led to four main themes: 1) diverse preferences as regards user involvement, 2) individual differences as regards information, knowledge and training, 3) feeling safe and getting help, and 4) a wish to stay at home for as long as possible. CONCLUSION The results indicated that user involvement was only to a limited extent an integral part of public home care services. Participants had varying insight into and interest in welfare technology, which was a challenge for user involvement. User involvement must be facilitated and implemented in a gentle way, highlighting autonomy and collaboration, and with the focus on respect, reciprocity and dialogue.
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Affiliation(s)
- Heidi Snoen Glomsås
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway.
| | - Ingrid Ruud Knutsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway
| | - Mariann Fossum
- Faculty of Health and Sport Sciences, Department of Health and Nursing Science, University of Agder, Postboks 509, N-4898, Grimstad, Norway
| | - Kristin Halvorsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway
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The seven key challenges for life-critical shared decision making systems. Int J Med Inform 2021; 148:104377. [PMID: 33517102 DOI: 10.1016/j.ijmedinf.2021.104377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Shared decision making (SDM) for life-critical diseases or conditions is a crucial type of SDM. This type of SDM is still greatly underdeveloped and it faces a number of key challenges. The main goal of this study is to identify the challenges that impede the development and use of life-critical SDM. METHODS This is a hybrid research and systematic / narrative review paper. Its results were derived by analyzing reviews already conducted by the authors when they were working on six recently published papers. These papers had collectively required two systematic reviews and four narrative reviews. The topics covered in the six published papers were related to computer-aided diagnosis (CAD) in medicine, the analysis of health state utilities, and the selection of the best treatment for life-critical diseases / conditions. A new narrative review was also executed to explore some new issues. RESULTS The key challenges for life-critical SDM relate to the following aspects: The mathematical models used to make the decisions, the data used to feed these models, the role the patient plays within the SDM framework, and finally, the role healthcare professionals play along with the pertinent rules and regulations that guide the use of this type of SDM today. CONCLUSIONS Life-critical SDM is the most important type of SDM. However, some challenges impede its successful development and use. A number of developments and enhancements need to be made urgently for this type of SDM to become widely acceptable and useful. The seven key challenges identified in this study and the suggested directions for future research offer a compelling path towards elevating life-critical SDM to the next level and do so both effectively and efficiently.
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Azzano P, Dufresne É, Poder T, Bégin P. Economic considerations on the usage of biologics in the allergy clinic. Allergy 2021; 76:191-209. [PMID: 32656802 DOI: 10.1111/all.14494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 12/27/2022]
Abstract
The advent of biologic therapies has transformed care for severe atopic disorders but their high cost poses new challenges with regard to long-term sustainability and fair allocation of resources. This article covers the basic concepts of cost-utility analyses and reviews the available literature on cost utility of biologic drugs in atopic disorders. When used within their limits as part of a multi-dimensional assessment, economic analyses can be extremely useful to guide decision-making and prioritization of care. Despite the good quality of most cost-utility analyses conducted for the use of biologics in asthma and other atopic diseases, their conclusions regarding cost-effectiveness are extremely variable. This is mainly due to the use of inconsistent estimates of health utility benefit with therapy. Development of reliable and validated instruments to measure disutility in atopic disorders and measure of indirect costs in atopic disease are identified as a priority for future research.
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Affiliation(s)
- Pauline Azzano
- Department of Pediatrics CHU Sainte‐Justine Montreal QC Canada
| | - Élise Dufresne
- Department of Pediatrics CHU Sainte‐Justine Montreal QC Canada
| | - Thomas Poder
- Department of Management, Evaluation and Health Policy School of Public Health University of Montreal Montreal QC Canada
- Research Center of the Institut Universitaire en Santé Mentale de Montréal Montreal QC Canada
| | - Philippe Bégin
- Department of Pediatrics CHU Sainte‐Justine Montreal QC Canada
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29
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Badia X, Vico T, Shepherd J, Gil A, Poveda-Andrés JL, Hernández C. Impact of the therapeutic positioning report in the P&R process in Spain: analysis of orphan drugs approved by the European Commission and reimbursed in Spain from 2003 to 2019. Orphanet J Rare Dis 2020; 15:224. [PMID: 32859228 PMCID: PMC7456380 DOI: 10.1186/s13023-020-01507-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Pricing and reimbursement decisions for orphan drugs are faced with differences access between European countries depending on each reimbursement policies, evaluation processes and timings. In 2013, the therapeutic positioning report was introduced in the pricing and reimbursement process in Spain. The present study aims to identify orphan drugs authorised in Spain and approved by the European Commission between January 2003 and December 2019, analyse the impact of the therapeutic positioning report in the pricing and reimbursement process of orphan drugs in Spain and to assess additional potential criteria that could influence pricing and reimbursement decisions for orphan drugs. RESULTS Ninety-four orphan drugs have been approved by the European Commission between January 2003 and December 2019 and have marketing authorisation in Spain. Out of the 94 orphan drugs, 46 (48.9%) had received pricing and reimbursement approval. Before the inclusion of the therapeutic positioning report in year 2013, the mean time from European Commission approval to pricing and reimbursement approval for orphan drugs in Spain was 25.1 ± 16.5. After 2013, timelines have been reduced by an average of 9 months. The mean regulatory time from European Commission approval to Spanish marketing authorisation has decreased nearly 4 months (from 7.5 ± 10.2 months in years 2003-2013 to 3.8 ± 7.6 months in years 2014-2019). The instauration of the therapeutic positioning report could be associated with a reduction of the mean time from the Spanish marketing authorisation to pricing and reimbursement approval by an average of 5 months (from 17.3 ± 13.1 months in years 2003-2013 to 12.3 ± 5 months in years 2014-2019). In addition, orphan drugs with a positive conclusion in the therapeutic positioning report would be more likely to be reimbursed in Spain (p < 0,0001). CONCLUSIONS This study shows that the therapeutic positioning report plays a key role in the pricing and reimbursement process in Spain. A positive conclusion of the therapeutic positioning report seems to favourably affect pricing and reimbursement decisions in Spain and, since its introduction, has also contributed to reduce pricing and reimbursement approval timelines in Spain.
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Affiliation(s)
| | - Tania Vico
- Omakase Consulting S.L., Barcelona, Spain
| | | | - Alicia Gil
- Omakase Consulting S.L., Barcelona, Spain
| | | | - César Hernández
- Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
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Jakab I, Németh B, Elezbawy B, Karadayı MA, Tozan H, Aydın S, Shen J, Kaló Z. Potential Criteria for Frameworks to Support the Evaluation of Innovative Medicines in Upper Middle-Income Countries-A Systematic Literature Review on Value Frameworks and Multi-Criteria Decision Analyses. Front Pharmacol 2020; 11:1203. [PMID: 32922287 PMCID: PMC7456841 DOI: 10.3389/fphar.2020.01203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background Multicriteria Decision Analysis (MCDA), a formal decision support framework, has been growing in popularity recently in the field of health care. MCDA can support pricing and reimbursement decisions on the macro level, which is of great importance especially in countries with more limited resources. Objectives The aim of this systematic review was to facilitate the development of future MCDA frameworks, by proposing a set of criteria focusing on the purchasing decisions of single-source innovative pharmaceuticals in upper middle-income countries. Methods A systematic literature review was conducted on the decision criteria included in value frameworks (VFs) or MCDA tools. Scopus, Medline, databases of universities, websites of Health Technology Assessment Agencies, and other relevant organizations were included in the search. Double title-abstract screening and double full-text review were conducted, and all extracted data were double-checked. A team of researchers performed the merging and selection process of the extracted criteria. Results A total of 1,878 articles entered the title and abstract screening. From these, 341 were eligible to the full-text review, and 36 were included in the final data extraction phase. From these articles 394 criteria were extracted in total. After deduplication and clustering, 26 different criteria were identified. After the merging and selection process, a set of 16 general criteria was proposed. Conclusion Based on the results of the systematic literature review, a pool of 16 criteria was selected. This can serve as a starting point for constructing MCDA frameworks in upper middle-income countries after careful adaptation to the local context.
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Affiliation(s)
- Ivett Jakab
- Syreon Research Institute, Budapest, Hungary
| | | | | | | | - Hakan Tozan
- İstanbul Medipol University, İstanbul, Turkey
| | | | - Jie Shen
- Novartis International AG, Basel, Switzerland
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.,Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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Alami H, Lehoux P, Auclair Y, de Guise M, Gagnon MP, Shaw J, Roy D, Fleet R, Ag Ahmed MA, Fortin JP. Artificial Intelligence and Health Technology Assessment: Anticipating a New Level of Complexity. J Med Internet Res 2020; 22:e17707. [PMID: 32406850 PMCID: PMC7380986 DOI: 10.2196/17707] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/25/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Artificial intelligence (AI) is seen as a strategic lever to improve access, quality, and efficiency of care and services and to build learning and value-based health systems. Many studies have examined the technical performance of AI within an experimental context. These studies provide limited insights into the issues that its use in a real-world context of care and services raises. To help decision makers address these issues in a systemic and holistic manner, this viewpoint paper relies on the health technology assessment core model to contrast the expectations of the health sector toward the use of AI with the risks that should be mitigated for its responsible deployment. The analysis adopts the perspective of payers (ie, health system organizations and agencies) because of their central role in regulating, financing, and reimbursing novel technologies. This paper suggests that AI-based systems should be seen as a health system transformation lever, rather than a discrete set of technological devices. Their use could bring significant changes and impacts at several levels: technological, clinical, human and cognitive (patient and clinician), professional and organizational, economic, legal, and ethical. The assessment of AI's value proposition should thus go beyond technical performance and cost logic by performing a holistic analysis of its value in a real-world context of care and services. To guide AI development, generate knowledge, and draw lessons that can be translated into action, the right political, regulatory, organizational, clinical, and technological conditions for innovation should be created as a first step.
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Affiliation(s)
- Hassane Alami
- Public Health Research Center, Université de Montréal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, École de santé publique de l'Université de Montréal, Montreal, QC, Canada
- Institut national d'excellence en santé et services sociaux, Montréal, QC, Canada
| | - Pascale Lehoux
- Public Health Research Center, Université de Montréal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, École de santé publique de l'Université de Montréal, Montreal, QC, Canada
| | - Yannick Auclair
- Institut national d'excellence en santé et services sociaux, Montréal, QC, Canada
| | - Michèle de Guise
- Institut national d'excellence en santé et services sociaux, Montréal, QC, Canada
| | - Marie-Pierre Gagnon
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, QC, Canada
- Faculty of Nursing Science, Université Laval, Quebec, QC, Canada
| | - James Shaw
- Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Denis Roy
- Institut national d'excellence en santé et services sociaux, Montréal, QC, Canada
| | - Richard Fleet
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- Research Chair in Emergency Medicine, Université Laval - CHAU Hôtel-Dieu de Lévis, Lévis, QC, Canada
| | - Mohamed Ali Ag Ahmed
- Research Chair on Chronic Diseases in Primary Care, Université de Sherbrooke, Chicoutimi, QC, Canada
| | - Jean-Paul Fortin
- Research Center on Healthcare and Services in Primary Care, Université Laval, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Öztürk N, Tozan H, Vayvay Ö. A New Decision Model Approach for Health Technology Assessment and A Case Study for Dialysis Alternatives in Turkey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103608. [PMID: 32455609 PMCID: PMC7277178 DOI: 10.3390/ijerph17103608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 11/16/2022]
Abstract
Background: This paper presents a generic Multi-Criteria Decision Analysis (MCDA) model for Health Technology Assessment (HTA) decision-making, which can be applied to a wide range of HTA studies, regardless of the healthcare technology type under consideration. Methods: The HTA Core Model® of EUnetHTA was chosen as a basis for the development of the MCDA model because of its common acceptance among European Union countries. Validation of MCDA4HTA was carried out by an application with the HTA study group of the Turkish Ministry of Health. The commitment of the decision-making group is completed via an online application of 10 different questionnaires. The Analytic Hierarchy Process (AHP) is used to determine the weights. Scores of the criteria in MCDA4HTA are gathered directly from the HTA report. The performance matrix in this application is run with fuzzy Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), fuzzy Vise Kriterijumska Optimizacija I Kompromisno Resenje (VIKOR), and goal programming MCDA techniques. Results: Results for fuzzy VIKOR, fuzzy TOPSIS, and goal programming are 0.018, 0.309, and 0.191 for peritoneal dialysis and 0.978, 0.677, and 0.327 for hemodialysis, respectively. Conclusions: Peritoneal dialysis is found to be the best choice under the given circumstances, despite its higher costs to society. As an integrated decision-making model for HTA, MCDA4HTA supports both evidence-based decision policy and the transparent commitment of multi-disciplinary stakeholders.
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Affiliation(s)
- Necla Öztürk
- Department of Engineering Management, Marmara University, 34083 Istanbul, Turkey
- Correspondence: ; Tel.: +49-151-257-151-18
| | - Hakan Tozan
- Affiliation Industrial Engineering Department, Medipol University, 34083 Istanbul, Turkey;
| | - Özalp Vayvay
- Faculty of Business, Marmara University, 34083 Istanbul, Turkey;
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Schey C, Postma MJ, Krabbe PFM, Topachevskyi O, Volovyk A, Connolly M. Assessing the Preferences for Criteria in Multi-Criteria Decision Analysis in Treatments for Rare Diseases. Front Public Health 2020; 8:162. [PMID: 32457865 PMCID: PMC7225315 DOI: 10.3389/fpubh.2020.00162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 04/16/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Increasingly, multi-criteria decision analysis has gained importance as a method by which to assess the value of orphan drugs. However, very little attention has been given to the weight (relative preferences) of the individual criteria used in a framework. Aims: This study sought to gain an understanding of the preferential weights that should be allocated in a multi-criteria decision analysis framework for orphan drugs, from a multi-stakeholder perspective. Method: Using key MCDA criteria for orphan drugs reported in the literature, we developed an interactive web-based survey tool to capture preferences for different criteria from a general stakeholder sample who were requested to assign weights from a reimbursement perspective. Each criterion could be assigned a weight on a sliding scale from 0 to 100% as long as the sum of all the criteria was 100%. We subsequently used the interactive tool with an expert focus group, followed up with a group discussion regarding each criterion and their perspectives on the weight that each criterion should be allocated when assessing an orphan drug. The expert focus group participants were then able to adjust their weights, if the group discussion had changed their perspectives. Results: The interactive tool was completed by 120 general stakeholder sample from a wide range of countries and professional backgrounds and an expert focus group of ten members. The results showed the differences in perspectives on the importance of criteria. Both groups considered Treatment efficacy to be the most important criterion. The general stakeholder sample weighted Treatment safety at 12.03% compared to the expert focus group's average of 20%. The results also demonstrated the value of the group discussion, which provided additional insights into the perspectives on the importance of criteria in assessing orphan drugs. Conclusion: This study aimed to contribute to the important aspect of preferences for different criteria in MCDA. This study sheds light on the important aspect of the preferences of the different criteria. All respondents agreed on the relative importance of Treatment efficacy and Treatment safety, criteria that are captured in conventional cost-effectiveness studies, but they also expressed the view that in addition to those, several disease-related and drug-related criteria should be included in MCDA frameworks for assessing orphan drugs.
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Affiliation(s)
- Carina Schey
- Global Market Access Solutions, St-Prex, Switzerland
- Unit of Pharmacotherapy, Epidemiology & Economics, Department of Pharmacy, University of Groningen, Groningen, Netherlands
- Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
| | - Maarten Jacobus Postma
- Unit of Pharmacotherapy, Epidemiology & Economics, Department of Pharmacy, University of Groningen, Groningen, Netherlands
- Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Paul F. M. Krabbe
- Department of Epidemiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, Netherlands
| | | | - Andrew Volovyk
- Department of Health Economics, Digital Health Outcomes LLC, Kyiv, Ukraine
| | - Mark Connolly
- Global Market Access Solutions, St-Prex, Switzerland
- Unit of Pharmacotherapy, Epidemiology & Economics, Department of Pharmacy, University of Groningen, Groningen, Netherlands
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Ni M, Borsci S, Walne S, Mclister AP, Buckle P, Barlow JG, Hanna GB. The Lean and Agile Multi-dimensional Process (LAMP) - a new framework for rapid and iterative evidence generation to support health-care technology design and development. Expert Rev Med Devices 2020; 17:277-288. [PMID: 32167800 DOI: 10.1080/17434440.2020.1743174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction: Health technology assessments (HTA) are tools for policymaking and resource allocation. Early HTAs are increasingly used in design and development of new technologies. Conducting early HTAs is challenging, due to a lack of evidence and significant uncertainties in the technology and the market. A multi-disciplinary approach is considered essential. However, an operational framework that can enable the integration of multi-dimensional evidence into commercialization remains lacking.Areas covered: We developed the Lean and Agile Multi-dimensional Process (LAMP), an early HTA framework, for embedding commercial decision-making in structured evidence generation activities, divided into phases. Diverse evidence in unmet needs, user acceptance, cost-effectiveness, and market competitiveness are being generated in increasing depth. This supports the emergence of design and value propositions that align technology capabilities and clinical and user needs.Expert opinion: We have been applying LAMP to working with medical device and diagnostic industry in the UK. The framework can be adapted to suit different technologies, decision needs, time scales, and resources. LAMP offers a practical solution to the multi-disciplinary approach. Methodologists drive the process by performing evidence generation and synthesis as and by enabling interactions between manufacturers, designers, clinicians, and other key stakeholders.
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Affiliation(s)
- Melody Ni
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simone Borsci
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Cognitive Psychology and Ergonomics, Twente University, Enschede, Netherlands
| | - Simon Walne
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anna P Mclister
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Peter Buckle
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - James G Barlow
- Imperial Business School, Imperial College London, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
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Hsu JC, Lin JY, Lin PC, Lee YC. Comprehensive value assessment of drugs using a multi-criteria decision analysis: An example of targeted therapies for metastatic colorectal cancer treatment. PLoS One 2019; 14:e0225938. [PMID: 31830075 PMCID: PMC6907782 DOI: 10.1371/journal.pone.0225938] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study is aimed toward establishing a decision-making model with multiple criteria for appraisal and reimbursement to compare the attitudes of different stakeholders toward various dimensions and criteria and to evaluate the five targeted therapies (bevacizumab, cetuximab, panitumumab, aflibercept, and regorafenib) for metastatic colorectal cancer. METHOD This study is a multi-criteria decision analysis (MCDA) using a model that includes three dimensions and nine criteria. Both the overall and individual scores of the respective targeted therapies in different dimensions and criteria were calculated. A sensitivity analysis was carried out in order to evaluate the robustness of the research results. An interview-based questionnaire survey was applied to obtain the performance information for the targeted therapies and the weights of the dimensions and criteria. RESULTS Overall, the clinical dimension had the highest weight, followed by the economic dimension, and finally, the social dimension. In the clinical dimension, the "comparative efficacy" criterion had the highest weight; in the economic dimension, the "cost-effectiveness" criterion" was given the greatest importance; in the social dimension, the "social concern and patient needs" criterion was given more emphasis. The overall values ranked from high to low as follows: cetuximab (overall score 3.3666), bevacizumab (3.3043), panitumumab (3.2030), aflibercept (2.8923) and regorafenib (2.8366). CONCLUSIONS A comprehensive value assessment system combining "multi-dimensional criteria," "multi-perspectives," and an "integrative assessment" is necessary to evaluate the value of medicines. The results showed not only the order of weights of different dimensions or criteria, but also the rankings of the value of the targeted therapies.
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Affiliation(s)
- Jason C. Hsu
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
| | - Jia-Yu Lin
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Peng-Chan Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yang-Cheng Lee
- Department of Internal Medicine, Tainan Municipal Hospital, Tainan, Taiwan
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Ghabri S, Josselin JM, Le Maux B. Could or Should We Use MCDA in the French HTA Process? PHARMACOECONOMICS 2019; 37:1417-1419. [PMID: 31565761 DOI: 10.1007/s40273-019-00846-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Salah Ghabri
- Department of Economic and Public Health Evaluation, French National Authority for Health (Haute Autorité de Santé, HAS), 5 Avenue du Stade de France, 93218, Saint-Denis La Plaine Cedex, France.
| | - Jean-Michel Josselin
- Faculty of Economics, University of Rennes 1, CREM-CNRS, Place Hoche 7, 35065, Rennes cedex, France
| | - Benoît Le Maux
- Faculty of Economics, University of Rennes 1, CREM-CNRS, Place Hoche 7, 35065, Rennes cedex, France
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Vreman RA, Heikkinen I, Schuurman A, Sapede C, Garcia JL, Hedberg N, Athanasiou D, Grueger J, Leufkens HGM, Goettsch WG. Unmet Medical Need: An Introduction to Definitions and Stakeholder Perceptions. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1275-1282. [PMID: 31708064 DOI: 10.1016/j.jval.2019.07.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/10/2019] [Accepted: 07/01/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Despite increasing informal and formal use of unmet medical need (UMN) in drug development, regulation, and assessment, there is no insight into its definitions in use. This study aims to provide insight into the current definitions in use and to provide a starting point for a multi-stakeholder discussion on alignment. METHODS A scoping and a gray literature review were performed to locate definitions of UMN in literature and on stakeholder websites. These definitions were categorized and then discussed among the multi-stakeholder author group via semistructured group discussions and open session workshops with a broader stakeholder audience. Issues with the formation of a common definition and mechanisms for use were discussed. RESULTS The reviews yielded 16 definitions. Differences were evident, but all included 1 or more of the following elements: (adequacy of) available treatments (16 of 16: 100%), disease severity or burden (6 of 16: 38%), and patient population size (1 of 16: 6%). The stakeholder discussions led to a suggestion for a definition including the first 2 items and, depending on context, population size. The discussions also showed that quantification of UMN is highly dependent on the scope and the value framework in which it is used based on different stakeholder preferences and responsibilities. CONCLUSION We encourage stakeholders that want to promote alignment on the concept of UMN to prospectively discuss the scope in which they want to apply the concept, what elements they find important for consideration in each case, and how they would measure UMN within the broader regulatory or value framework applicable.
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Affiliation(s)
- Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; National Health Care Institute, Diemen, The Netherlands
| | | | - Ad Schuurman
- National Health Care Institute, Diemen, The Netherlands
| | | | | | - Niklas Hedberg
- The Dental and Pharmaceuticals Benefits Agency, Stockholm, Sweden
| | - Dimitrios Athanasiou
- World Duchenne Organization, Stichting United Parent Projects Muscular Dystrophy, Zeist, The Netherlands
| | | | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; National Health Care Institute, Diemen, The Netherlands.
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Álvarez-Román MT, Cuervo-Arango I, Pérez-Santamarina R, Poveda JL, Romero JA, Santamaría A, Trillo-Mata JL, Tort M, Badia X. Determining the value contribution of emicizumab (Hemlibra®) for the prophylaxis of haemophilia A with inhibitors in Spain by multi-criteria decision analysis. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2019. [DOI: 10.1177/2284240319880534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patients with moderate to severe haemophilia A are at a higher risk of developing FVIII inhibitors that require the use of more costly and less effective treatments. The objective of this study was to determine the value of emicizumab for the prophylaxis of haemophilia A with inhibitors compared to the current therapeutic alternatives, activated prothrombin complex concentrate and recombinant factor VIIa through reflective Multi-Criteria Decision Analysis. The EVIDEM framework adapted to orphan drugs and weighted by a sample of 98 national and regional Spanish evaluators was used. Two structured evidence matrices were developed: emicizumab against activated prothrombin complex concentrate and emicizumab against recombinant factor VIIa. A multidisciplinary team of haemophilia experts rated each of the criteria. Mean and standard deviation were calculated by each criterion and discussed among all participants. Haemophilia A with inhibitors was perceived as a severe disease with high unmet needs. Emicizumab was rated with higher efficacy, therapeutic benefit and quality of life than comparators. When administered alone for the prevention of bleeding events, emicizumab had slightly better safety and tolerability profile than activated prothrombin complex concentrate and similar with recombinant factor VIIa. The inclusion of emicizumab in clinical practice guidelines was valued positively by the members of the panel. Overall, value of emicizumab was higher than activated prothrombin complex concentrate and recombinant factor VIIa, mostly because of efficacy and therapeutic benefit in reducing treated haemorrhages. Reflective Multi-Criteria Decision Analysis has proven to be a feasible method to determine the value contribution of comparative therapies in haemophilia.
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Frutos Pérez-Surio A, Gimeno-Gracia M, Alcácera López MA, Sagredo Samanes MA, Pardo Jario MDP, Salvador Gómez MDT. Systematic review for the development of a pharmaceutical and medical products prioritization framework. J Pharm Policy Pract 2019; 12:21. [PMID: 31452901 PMCID: PMC6702737 DOI: 10.1186/s40545-019-0181-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/15/2019] [Indexed: 12/04/2022] Open
Abstract
Objective 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. Conclusions 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. Electronic supplementary material The online version of this article (10.1186/s40545-019-0181-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alberto Frutos Pérez-Surio
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain.,2Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, C/Domingo Miral s/n 50009, Zaragoza, Spain
| | - Mercedes Gimeno-Gracia
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain.,3IIS Aragón, Zaragoza, Spain
| | - Ma Aránzazu Alcácera López
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain
| | - Ma Asunción Sagredo Samanes
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain
| | - Ma Del Puerto Pardo Jario
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain
| | - Ma Del Tránsito Salvador Gómez
- Department of Hospital Pharmacy, University Clinical Hospital Lozano Blesa. Avda. San Juan Bosco 15, 50009 Zaragoza, Spain
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Badia X, Chugani D, Abad MR, Arias P, Guillén-Navarro E, Jarque I, Posada M, Vitoria I, Poveda JL. Development and validation of an MCDA framework for evaluation and decision-making of orphan drugs in Spain. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1652163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - María Reyes Abad
- Servicio de Farmacia, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Patricia Arias
- Spanish Federation of Rare Diseases (FEDER), Madrid, Spain
| | - Encarnación Guillén-Navarro
- Sección de Genética Médica, Servicio de Pediatría, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca. Universidad de Murcia. Murcia, Spain & Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Isidro Jarque
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, Spain & Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Posada
- Instituto de Investigación en Enfermedades Raras (IIER), Madrid, Spain & Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Isidro Vitoria
- Unidad de Nutrición y Metabolopatías, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jose Luis Poveda
- Servicio de Farmacia, Área del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Rare Diseases and Orphan Drugs Group of the Spanish Society of Hospital Pharmacy (OrPhar-SEFH), Madrid, Spain
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Oliveira MD, Mataloto I, Kanavos P. Multi-criteria decision analysis for health technology assessment: addressing methodological challenges to improve the state of the art. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:891-918. [PMID: 31006056 PMCID: PMC6652169 DOI: 10.1007/s10198-019-01052-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/14/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Multi-criteria decision analysis (MCDA) concepts, models and tools have been used increasingly in health technology assessment (HTA), with several studies pointing out practical and theoretical issues related to its use. This study provides a critical review of published studies on MCDA in the context of HTA by assessing their methodological quality and summarising methodological challenges. METHODS A systematic review was conducted to identify studies discussing, developing or reviewing the use of MCDA in HTA using aggregation approaches. Studies were classified according to publication time and type, country of study, technology type and study type. The PROACTIVE-S approach was constructed and used to analyse methodological quality. Challenges and limitations reported in eligible studies were collected and summarised; this was followed by a critical discussion on research requirements to address the identified challenges. RESULTS 129 journal articles were eligible for review, 56% of which were published in 2015-2017; 42% focused on pharmaceuticals; 36, 26 and 18% reported model applications, issues regarding MCDA implementation analyses, and proposing frameworks, respectively. Poor compliance with good methodological practice (< 25% complying studies) was found regarding behavioural analyses, discussion of model assumptions and uncertainties, modelling of value functions, and dealing with judgment inconsistencies. The five most reported challenges related to evidence and data synthesis; value system differences and participant selection issues; participant difficulties; methodological complexity and resource balance; and criteria and attributes modelling. A critical discussion on ways to address these challenges ensues. DISCUSSION Results highlight the need for advancement in robust methodologies, procedures and tools to improve methodological quality of MCDA in HTA studies. Research pathways include developing new model features, good practice guidelines, technologies to enable participation and behavioural research.
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Affiliation(s)
- Mónica D Oliveira
- CEG-IST, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal.
| | - Inês Mataloto
- CEG-IST, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Panos Kanavos
- Department of Health Policy and Medical Technology Research Group, LSE Health London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Guarga L, Badia X, Obach M, Fontanet M, Prat A, Vallano A, Torrent J, Pontes C. Implementing reflective multicriteria decision analysis (MCDA) to assess orphan drugs value in the Catalan Health Service (CatSalut). Orphanet J Rare Dis 2019; 14:157. [PMID: 31248421 PMCID: PMC6598260 DOI: 10.1186/s13023-019-1121-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/07/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Orphan medicines show some characteristics that hinder the evaluation of their clinical added value. The often low level of evidence available for orphan drugs, together with a high budget impact and an incremental cost-effectiveness ratio many times higher than drugs used for non-orphan diseases, represent challenges in their appraisal and effective access to clinical use. In order to explore how to handle these hurdles, the Catalan Health Service (CatSalut) began an initiative on a multidimensional assessment of drugs value during the appraisal process. Reflective multicriteria decision analysis (MCDA) using analytical methods was chosen, since it may help to standardise and contextualize all the relevant data related with the drug that could contribute to a decision. The aim of the study was to determine whether the implementation of reflective MCDA methodology could support the decision-making process about orphan medicines in the context of CatSalut. METHODS The assessment and decision-making process for orphan drugs in the Programa d'Harmonització Farmacoterapeutica (PHF) of CatSalut was prioritized to test the implementation of the reflective MCDA both a qualitative and quantitatively. A staged approach was used with the following main steps: selection and structuration of quantitative criteria (Core Model) and qualitative criteria (Contextual Tool), framework scoring and assessment of three orphan drug case studies. This proof-of-concept would grant a continued refinement of the methodology and, if and when validated, its potential integration to other therapeutic areas of the PHF. RESULTS The final framework was composed by 10 quantitative criteria (Core Model) and 4 qualitative criteria (Contextual Tool) according to the PHF goals being the most important criteria "disease severity", "unmet need", "comparative effectiveness" and "comparative safety /tolerability". The matrix developed for the case studies served as a guide for the selection of the essential information that the decision-makers were expected to include in a framework. The reflective discussion was considered the most relevant phase of the approach to support inputs for health decision-making processes reflecting both drug value and place in therapy. CONCLUSIONS The study showed that reflective MCDA methodology could be implemented to complement the decision-making process in CatSalut, as an aid to determine the clinical added value for orphan medicines. MCDA provided transparency and a structured discussion during the committee meetings, thus increasing transparency and predictability of the relevant items supporting the agreements adopted on orphan drugs access.
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Affiliation(s)
- Laura Guarga
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
- Omakase Consulting S.L., Entença street 332334 Floor 6, door 4, 08029 Barcelona, Spain
| | - Xavier Badia
- Omakase Consulting S.L., Entença street 332334 Floor 6, door 4, 08029 Barcelona, Spain
| | - Mercè Obach
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
| | - Manel Fontanet
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Av. de Can Domènech, 737, 08193 Cerdanyola del Vallès (Barcelona), Spain
| | - Alba Prat
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
| | - Atonio Vallano
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
| | - Josep Torrent
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
| | - Caridad Pontes
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Av. de Can Domènech, 737, 08193 Cerdanyola del Vallès (Barcelona), Spain
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Velazquez Berumen A, Jimenez Moyao G, Rodriguez NM, Ilbawi AM, Migliore A, Shulman LN. Defining priority medical devices for cancer management: a WHO initiative. Lancet Oncol 2019; 19:e709-e719. [PMID: 30507437 DOI: 10.1016/s1470-2045(18)30658-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 01/17/2023]
Abstract
Medical devices are indispensable for cancer management across the entire cancer care continuum, yet many existing medical interventions are not equally accessible to the global population, contributing to disparate mortality rates between countries with different income levels. Improved access to priority medical technologies is required to implement universal health coverage and deliver high-quality cancer care. However, the selection of appropriate medical devices at all income and hospital levels has been difficult because of the extremely large number of devices needed for the full spectrum of cancer care; the wide variety of options within the medical device sector, ranging from small inexpensive disposable devices to sophisticated diagnostic imaging and treatment units; and insufficient in-country expertise, in many countries, to prioritise cancer interventions and to determine associated technologies. In this Policy Review, we describe the methods, process, and outcome of a WHO initiative to define a list of priority medical devices for cancer management. The methods, approved by the WHO Guidelines Review Committee, can be used as a model approach for future endeavours to define and select medical devices for disease management. The resulting list provides ready-to-use guidance for the selection of devices to establish, maintain, and operate necessary clinical units within the continuum of care for six cancer types, with the goal of promoting efficient resource allocation and increasing access to priority medical devices, particularly in low-income and middle-income countries.
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Affiliation(s)
| | | | - Natalia M Rodriguez
- Institute for Advanced Study of the Americas, and Department of Anthropology, College of Arts and Sciences, University of Miami, Florida, FL, USA
| | - André M Ilbawi
- Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, WHO, Geneva, Switzerland
| | - Antonio Migliore
- Agenas, Agenzia nazionale per i servizi sanitari regionali, Rome, Italy
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, PA, USA
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Why We Don't Need "Unmet Needs"! On the Concepts of Unmet Need and Severity in Health-Care Priority Setting. HEALTH CARE ANALYSIS 2019; 27:26-44. [PMID: 30178073 DOI: 10.1007/s10728-018-0361-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity (and where other features also equals each other).
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Al-Mawali A, Pinto AD, Al-Hinai AT. Medical Equipment and Healthcare Technology: Health Vision 2050. Biomed Instrum Technol 2019; 52:442-450. [PMID: 30479156 DOI: 10.2345/0899-8205-52.6.442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To address the demands of worldwide demographic and epidemiologic changes and globalization, as well as their effects on population health, the Ministry of Health in Oman developed a long-term plan for its health system called Health Vision 2050. The plan was shaped by international consultants, who sought to augment the vision with up-to-date evidence and achieve alignment with international standards. The Health Vision 2050 main document was anchored by 24 separate strategic studies covering different dimensions and pillars of the health system, one of which was the strategic study of medical equipment and healthcare technology (MEHT). This study analyzed the current status of MEHT, highlighted the achievements and bottlenecks, anticipated future challenges, and determined the future vision through pragmatic, contextualized, and actionable objectives and strategies that will provide a platform for comprehensive MEHT planning. Of note, pharmacological technologies, pharmaceutical drugs, and information technology have not been covered under the scope of this vision. By shedding light on this important strategic study about MEHT, the aim of this article is to assist other countries that are seeking to improve their MEHT based on the latest international guidelines and standards.
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Glaize A, Duenas A, Di Martinelly C, Fagnot I. Healthcare decision-making applications using multicriteria decision analysis: A scoping review. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2019. [DOI: 10.1002/mcda.1659] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Annabelle Glaize
- Management Department; IÉSEG School of Management, LEM-CNRS (UMR 9221)
| | - Alejandra Duenas
- Business Environment; ICN Business School, CERFIGE; Nancy France
| | | | - Isabelle Fagnot
- Management Department; Audencia Business School; Nantes France
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Rehfuess EA, Stratil JM, Scheel IB, Portela A, Norris SL, Baltussen R. The WHO-INTEGRATE evidence to decision framework version 1.0: integrating WHO norms and values and a complexity perspective. BMJ Glob Health 2019; 4:e000844. [PMID: 30775012 PMCID: PMC6350705 DOI: 10.1136/bmjgh-2018-000844] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/05/2018] [Accepted: 07/20/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Evidence-to-decision (EtD) frameworks intend to ensure that all criteria of relevance to a health decision are systematically considered. This paper, part of a series commissioned by the WHO, reports on the development of an EtD framework that is rooted in WHO norms and values, reflective of the changing global health landscape, and suitable for a range of interventions and complexity features. We also sought to assess the value of this framework to decision-makers at global and national levels, and to facilitate uptake through suggestions on how to prioritise criteria and methods to collect evidence. METHODS In an iterative, principles-based approach, we developed the framework structure from WHO norms and values. Preliminary criteria were derived from key documents and supplemented with comprehensive subcriteria obtained through an overview of systematic reviews of criteria employed in health decision-making. We assessed to what extent the framework can accommodate features of complexity, and conducted key informant interviews among WHO guideline developers. Suggestions on methods were drawn from the literature and expert consultation. RESULTS The new WHO-INTEGRATE (INTEGRATe Evidence) framework comprises six substantive criteria-balance of health benefits and harms, human rights and sociocultural acceptability, health equity, equality and non-discrimination, societal implications, financial and economic considerations, and feasibility and health system considerations-and the meta-criterion quality of evidence. It is intended to facilitate a structured process of reflection and discussion in a problem-specific and context-specific manner from the start of a guideline development or other health decision-making process. For each criterion, the framework offers a definition, subcriteria and example questions; it also suggests relevant primary research and evidence synthesis methods and approaches to assessing quality of evidence. CONCLUSION The framework is deliberately labelled version 1.0. We expect further modifications based on focus group discussions in four countries, example applications and input across concerned disciplines.
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Affiliation(s)
- Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Inger B Scheel
- Department of Global Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Susan L Norris
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Rob Baltussen
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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Castro HE, Moreno-Mattar O, Rivillas JC. HTA and MCDA solely or combined? The case of priority-setting in Colombia. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:47. [PMID: 30455606 PMCID: PMC6225554 DOI: 10.1186/s12962-018-0127-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background All healthcare systems face problems of justice and efficiency related to setting priorities for allocating limited financial resources. Therefore, explicit decision-making in healthcare depicted as a continuum from evidence generation to deliberation and communication of the decision made, needs to be transparent and fair. Nevertheless, priority-setting in many parts of the world remains being implicit and ad-hoc process. Health Technology Assessment (HTA) and Multi-Criteria Decision Analysis (MCDA) have emerged as policy tools to assist informed decision-making. Both, MCDA and HTA have pros and cons. Main body Colombia experienced an important institutional transformation after the establishment of the Health Technology Assessment Institute in 2012. This paper briefly presents the current challenges of the Colombian health system, the general features of the new health sector reform, the main characteristics of HTA in Colombia and the potential benefits and caveats of incorporating MCDA approaches into the decision-making process. Conclusion Structured and objective consideration of the factors that are both measurable and value-based in an open and transparent manner may be feasible through combining HTA and MCDA in contexts like Colombia. Further testing and validation of HTA and MCDA solely or combined in LMICs are needed to advance these approaches into healthcare decision-making worldwide.
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Affiliation(s)
- Héctor E Castro
- Pharmaceutical Economics & Financing EN Management Sciences for Health, Manager Sciences for Health, Arlington, USA
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MULTI-CRITERIA DECISION ANALYSIS AS A DECISION-SUPPORT TOOL FOR DRUG EVALUATION: A PILOT STUDY IN A PHARMACY AND THERAPEUTICS COMMITTEE SETTING. Int J Technol Assess Health Care 2018; 34:519-526. [DOI: 10.1017/s0266462318000569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives:The aim of this study was to develop and to assess a specific Multi-Criteria Decision Analysis (MCDA) framework to evaluate new drugs in an hospital pharmacy and therapeutics committee (P&TC) setting.Methods:A pilot criteria framework was developed based on the EVIDEM (Evidence and Value: Impact on DEcisionMaking) framework, together with other relevant criteria, and assessed by a group of P&TC's members. The weighting of included criteria was done using a 5-point weighting technique. Two drugs were chosen by evaluation: an orphan-drug for Gaucher disease, and a nonorphan drug for the treatment of inflammatory bowel disease. Evidence matrices were developed, and value contribution of each drug was evaluated by P&TC's members. An agreed final framework was obtained through a discussion between the P&TC's members.Results:After criteria assessment, the pilot framework included eight quantitative criteria: “disease severity,” “unmet needs,” “comparative efficacy/effectiveness,” “comparative safety/tolerability,” “comparative patient-reported outcomes,” “comparative cost consequences-cost of treatment,” “comparative cost consequences-other medical costs,” and “quality of evidence”; and one contextual criterion: “opportunity costs and affordability.” The most valued criteria were: “comparative safety/tolerability,” “disease severity,” and “comparative efficacy/effectiveness.” When assessing the drugs most valued characteristics of the MCDA were the possibility that all team may contribute to drug assessment by means of scoring the matrices and the discussion to reach a consensus in drug positioning and value decision making.Conclusions:The reflective MCDA would integrate quantitative and qualitative criteria relevant for a P&TC setting, allowing reflective discussions based on the criteria weighting score.
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Howard S, Scott IA, Ju H, McQueen L, Scuffham PA. Multicriteria decision analysis (MCDA) for health technology assessment: the Queensland Health experience. AUST HEALTH REV 2018; 43:591-599. [PMID: 30205873 DOI: 10.1071/ah18042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/09/2018] [Indexed: 11/23/2022]
Abstract
Objectives In determining whether new health technologies should be funded, health technology assessment (HTA) committees prefer explicit to implicit methods of analysis in enhancing transparency and consistency of decision making. The aim of this study was to develop and pilot a multicriteria decision analysis (MCDA) framework for the Queensland Department of Health HTA program committee, which weighted decision making criteria according to their perceived importance as determined by group consensus. Methods The criteria used in the MCDA framework were identified by reviewing the five unweighted criteria used in the existing process, consultation with committee members and literature review. Criteria were clearly defined and ordinal categories of lowest to highest preferred were assigned against which technology submissions would be rated. Criteria weights were determined through a discrete choice experiment (DCE) survey of committee members using validated software. Mean weighted technology scores were then used to guide deliberative discussions in determining final funding decisions. Results The MCDA framework created one additional criterion to the previous five. The criteria and their mean weights identified through the DCE survey were clinical benefit and safety (27.2%), quality of evidence (19.2%), implementation capacity (16.9%), innovation (15.4%), burden of disease and clinical need (13.3%) and societal and ethical values (8.0%). Criterion weights varied considerably between individual committee members, with one criterion having a difference of 36.9% between the highest and lowest preference weights. Following deliberative discussions, all but one of 10 submissions were awarded funding. The submission not supported received the third lowest score through the MCDA model. Conclusions This pilot application of an MCDA framework, as a complement to committee deliberation, conferred greater transparency and objectivity on HTA assessment of technologies. The framework converted an implicit, unweighted review process to one that is more explicit, flexible in weighting importance and pragmatic. What is known about the topic? HTA programs involve complex decision-making processes requiring the consideration of multiple criteria. Explicit methods of analysis that use weighted criteria according to their relative importance enhance transparency and consistency of decision making by HTA committees, and are preferred to implicit reviews using unweighted criteria. What does this paper add? This article describes the development and piloting of an MCDA framework that aims to improve transparency, objectivity and consistency of funding decisions of the Queensland HTA committee. Criteria were identified through a review of current processes, committee discussions and a literature review, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) quality of evidence system. Criteria were weighted using a discrete choice experiment involving committee members. Using weighted criteria, mean technology scores were calculated and incorporated into deliberative discussions to determine funding decisions. What are the implications for practitioners? The MCDA framework described here converted a more implicit, unweighted process to one that was more pragmatic, explicit and flexible in scoring HTA submissions. This framework may be useful to other HTA programs and could be expanded to resource allocation decision making in many other healthcare settings.
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Affiliation(s)
- Sarah Howard
- Healthcare Evaluation and Assessment of Technology, Healthcare Improvement Unit, Clinical Excellence Division, Queensland Department of Health, Level 2, 15 Butterfield Street, Herston, Qld 4006, Australia. Email
| | - Ian A Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia. Email
| | - Hong Ju
- Agency for Care Effectiveness, Ministry of Health, 16 College Road, Singapore. Email
| | - Liam McQueen
- Healthcare Evaluation and Assessment of Technology, Healthcare Improvement Unit, Clinical Excellence Division, Queensland Department of Health, Level 2, 15 Butterfield Street, Herston, Qld 4006, Australia. Email
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Qld 4111, Australia. Email
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