Comprehensive value assessment of drugs using a multi-criteria decision analysis: An example of targeted therapies for metastatic colorectal cancer treatment

Abstract

ObjectiveThis 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.MethodThis 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.ResultsOverall, 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).ConclusionsA 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.

Potential approaches for the pricing of cancer medicines across Europe to enhance the sustainability of healthcare systems and the implications

“…Other proposals include the development of new multicriteria decision analyses (MCDAs) models [50,51] as well as potentially de-linkage models combining academic consortia with separate manufacturers to make new oncology medicines available at low prices [52]. Alongside this, we are already seeing countries and regions in Europe and wider become appreciably more pro-active in their approaches to funding new medicines in designated populations starting up to three years pre-launch and continuing post-launch to assess their role and value in routine clinical care [53,54].…”

“…Multicriteria for assessing the value of targeted therapies for colorectal cancer [adapted from Hsu et al[50]]. …”

Interoperability Assessment of Emergency Department Processes Based on Multicriteria Decision-Making Methods

“…[30] reasoned that MCDA could be applied to any field of emergency medicine. Regarding public health, [28] affirm that, recently, MCDAs have been more utilized because, conducting a systematic scientific empirical assessment designed to evaluate medical technology, they allow government managers and agencies to support appropriate decisions on healthcare.…”

“…The MCDA (multicriteria decision analysis) is a discipline that evaluates multiple conflicting criteria in decision-making, facilitating the choice of a solution in scenarios with several qualitative and quantitative variables, useful for benefit-risk analysis. As the volume and complexity of health data, information, and knowledge is growing, the MCDA has become invested with more potential in optimizing decision-making at any level of HC [26][27][28]. Its popularity in HC is explained by the large variety of attributes that exist in such a context [29].…”

Variation in the prices of oncology medicines across Europe and the implications for the future

“…This is because European countries have funded new cancer medicines at high prices in recent years despite limited health gain and formal pricing and reimbursement processes among European them (23)(24)(25)(26), exacerbated by the emotive nature of the disease area (12). These concerns are also leading to calls for alternative pricing and funding approaches towards new oncology medicines in Europe and wider, which include fair pricing models (25,(27)(28)(29)(30)(31). Fair pricing models necessarily include greater transparency in how prices are set, which is a continuing goal of the World Health Organisation (WHO) to improve access to new medicines for all patients including those for cancer (32,33).…”