Applying a Multicriteria Decision Analysis (MCDA) Approach to Elicit Stakeholders’ Preferences in Italy: The Case of Obinutuzumab for Rituximab-Refractory Indolent Non-Hodgkin Lymphoma (iNHL)

Abstract

BackgroundHealthcare decision makers need to make trade-offs between different elements of value of new treatments. Multicriteria decision analysis (MCDA) provides a framework that can help decision makers to understand stakeholders’ preferences and be explicit about the trade-offs that are being made.ObjectiveThe objective of this study was to use MCDA to obtain preferences and views on decision criteria across three stakeholder groups (patients, clinicians and payers) in Italy and to use these to assess the performance of obinutuzumab for rituximab-refractory indolent non-Hodgkin lymphoma (iNHL).MethodsWe used EVIDEM V3.0, an MCDA framework, and collected participants’ preferences via an online survey and structured meetings.ResultsPatients and clinicians expressed a preference for interventions targeting severe conditions. Payers expressed preference for treatments targeting areas with an unmet need, which are cheaper than the comparator, and with high-quality evidence. Obinutuzumab in combination with bendamustine, compared with bendamustine alone, received high positive scores for the criteria ‘disease severity’ and ‘type of therapeutic benefit’ by all three groups, and negative scores on the economic-related criteria, according to all stakeholder groups.ConclusionsMCDA can be used to elicit the views of different stakeholder groups and has the potential to structure and inform reimbursement decisions.Electronic supplementary materialThe online version of this article (doi:10.1007/s41669-017-0048-x) contains supplementary material, which is available to authorized users.

Multi-Criteria Decision Analysis (MCDA) Models in Health Technology Assessment of Orphan Drugs—a Systematic Literature Review. Next Steps in Methodology Development?

“…In 8 studies weights were assigned to criteria based on stakeholder input [Trip et al ( 36 ), Sussex et al ( 37 ), Gilabert-Perramon et al ( 44 ), Garau et al ( 45 ), Iskrov et al ( 35 ), Fedyeva et al, Wagner et al ( 43 ) Piniazkho et al ( 40 ), and Piniazkho and Nemeth ( 41 )] and in one publication weights were allocated by the authors [Wagner et al ( 25 )]. Two articles provided suggestions for MCDA score definition and calculation [Kolasa et al ( 34 ) and Hughes-Wilson et al ( 33 )].…”

“…Trip et al ( 36 ), Iskrov et al ( 35 ), Kolasa et al ( 34 ), Sussex et al ( 37 ), Schey et al ( 46 ), Piniazkho et al ( 40 ), Wagner et al ( 43 ), Schey et al ( 46 ), Tony et al ( 47 ), Badia et al ( 50 ), Garau et al ( 45 ), Jimenez et al ( 48 ), Fedyaeva et al and Krysanova et al ( 49 ) performed a test of the MCDA model for orphan drug evaluation in their research. Hughes-Wilson et al did not provide any information on testing the Transparent Value Framework MCDA model in the identified publication, however, the model was later tested within the EU MoCA project 6 .…”

“…The EVIDEM framework was the most researched model in the identified publications: its applicability was assessed by: Jimenez et al ( 48 ) in Spain (v 4.0), by Garau et al ( 45 ) in Italy (v3.0), by Gilabert-Perramon et al ( 44 ) in Catalonia (v3.0) and by Badia et al ( 50 ), Tony et al ( 47 , 58 ) and Wagner et al ( 43 ) in Italy, Spain and France (v2.4), respectively. In addition, Gilabert-Perramon et al ( 44 ) compared the EVIDEM framework to the current HTA system in place in Catalonia (PASFTAC).…”

“…The most commonly chosen criteria for the creation of the MCDA models were: Comparative effectiveness/efficacy [8 models, 13 publications: Gilabert-Perramon et al ( 44 ) and Wagner et al ( 25 , 43 ), Garau et al ( 45 ), Iskrov et al ( 35 ), Schey et al ( 46 ), Kolasa et al ( 34 ), Sussex et al ( 37 ), Hughes-Wilson et al ( 33 ), Trip et al ( 36 ), Annemans et al ( 30 ), Piniazkho et al ( 40 ), and Piniazkho and Nemeth ( 41 )] while a standard cost-effectiveness analysis was used in 3 (Trip et al ( 36 ), Iskrov et al ( 35 ), and Kolasa et al ( 34 )]. Unmet need/availability of therapeutic alternatives [7 models, 11 publications: Gilabert-Perramon et al ( 44 ), Wagner et al ( 25 , 43 ), Garau et al ( 45 ), Iskrov et al ( 35 ), Schey et al ( 46 ), Kolasa et al ( 34 ), Sussex et al ( 37 ), Hughes-Wilson et al ( 33 ), Trip et al ( 36 ), and Annemans et al ( 30 )]. Disease severity [7 models, 11 publications: Gilabert-Perramon et al ( 44 ), Wagner et al( 25 , 43 ), Garau et al ( 45 ), Trip et al ( 36 ), Iskrov et al ( 35 ), Schey et al ( 46 ), Kolasa et al ( 34 ), Sussex et al ( 37 ), Hughes-Wilson et al ( 33 ), and Annemans et al ( 30 )].…”

A Review of Rare Disease Policies and Orphan Drug Reimbursement Systems in 12 Eurasian Countries

“…Researchers in the rare disease area are also looking into the use of MCDA, which has resulted in a list of scientific publications and MCDA model designs, but full consensus on MCDA is still lacking and further research is needed to support implementation in (rare disease) HTA (94,(101)(102)(103)(104)(105)(106)(107)(108)(109)(110)(111)(112)(113)(114)(115)(116).…”