Appraising the Value of Lenvatinib for Radio-Iodine Refractory Differentiated Thyroid Cancer (Rr-Dtc): A Multi-Country Study Applying Holistic Multicriteria Decision Analysis (Mcda)

Abstract

A477value-based pricing, which reflects disease burden, therapeutic innovation, and social values, is suggested. This study attempts to measure the importance of costeffectiveness and other values for a new anticancer drug. Methods: Through literature reviews and experts' advices, eight health insurance benefit criteria were selected: disease severity, size of population affected by disease, pediatric medicine, alternative drugs, innovativeness, clinical benefit, cost-effectiveness, and budget impact. Preference for the criteria was investigated by using Discrete Choice Experiments(DCE), Analytic Hierarchy Process (AHP), swing weighting (SWING), and direct point allocation (DIRECT). The survey was conducted in three hundred general population through face to face interview. Respondents were selected using stratified random sampling by age, sex and region. The conditional logistic regression for DCE was conducted with STATA ver.12. Results: In the preference investigation using DCE, people preferentially considered disease severity (OR: 1.837, 95% CI: 1.673 to 2.017), alternative drugs (OR: 1.556, 95% CI: 1.458 to 1.661), and size of population affected by disease (OR: 1.408, 95% CI: 1.285 to 1.543). According to the results by using AHP, respondents considered clinical benefit to be the most important, followed by cost-effectiveness and disease severity as the main evaluation items. As estimated by SWING and DIRECT, clinical benefit was also evaluated as the most important item. There was no difference in the first to third priority evaluation items between SWING and DIRECT. ConClusions: The priorities derived from all methodologies show that clinical benefit and disease severity were more important than cost-effectiveness in general terms. In the situation where decision-making is mostly centered on cost-effectiveness, our results may be seen as the social demand that clinical benefit and the influence of applicable disease should be reflected appropriately in the insurance coverage.

Delivering Diabetes Education through Nurse-Led Telecoaching. Cost-Effectiveness Analysis

“…At present, reimbursement decisions in healthcare frequently lack a systematic approach [ 62 ]. Policy tools such as priority setting and multi-criteria decision-making are being explored and have the potential to increase the transparency of reimbursement decisions [ 60 , 63 – 65 ].…”

A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX-EMD Study

“…In our country, Spain, only a few MCDAs have been published in the field of healthcare [20][21][22][23][24][25][26][27][28], although the number of healthcare-related publications that incorporate MCDA is increasing in Spain and globally.…”

“…Some MCDAs have been used in our country to compare alternative treatments for various pathologies, such as chronic dermatological inflammatory diseases, cancer, rare diseases, and cardiovascular diseases such as nonvalvular atrial fibrillation and pulmonary hypertension [24][25][26]28]. Other applications of MCDA include the development of an assessment framework for rare diseases at a regional level in Catalonia [22] and the development of a decision-support tool for drug evaluation in a pharmacy and therapeutics committee setting at the hospital level [20].…”

“…Some studies have used the EVIDEM methodology to develop the analysis [20,[22][23][24][25]28]. In those studies, the methods used to prioritize the criteria were fundamentally compositional, such as direct classification or the analytic hierarchical process [22][23][24][25][26][27][28].…”

“…Some studies have used the EVIDEM methodology to develop the analysis [20,[22][23][24][25]28]. In those studies, the methods used to prioritize the criteria were fundamentally compositional, such as direct classification or the analytic hierarchical process [22][23][24][25][26][27][28]. Either a single-stakeholder perspective was used, such as that of patients [20,21,26] or evaluation agencies [22,27], or a multidisciplinary perspective was employed, which included patients, physicians, and other stakeholders [23][24][25]28].…”