Development of a Multicriteria Decision Analysis Framework for Evaluating and Positioning Oncologic Treatments in Clinical Practice

Abstract

PURPOSE: Several frameworks have been developed to define and quantify the value of oncologic therapies and to support decision making; however, they define treatment value mainly in terms of clinical benefit. As part of its mission to improve oncologic care, the ECO Foundation (Excellence and Quality in Oncology) directed this pilot study aimed at developing a reflective multicriteria decision analysis (MCDA)–based framework for evaluating and positioning oncologic drugs in the clinical setting. METHODS: The framework was developed following Evidence and Value: Impact on Decision-Making methodology, and literature was reviewed to identify relevant criteria. The selected criteria were then presented to a group of experts composed of 9 clinical oncologists who assessed each criterion for inclusion in the framework and suggested modifications in their definition and/or response scale. The framework was tested in 2 case studies (abemaciclib for advanced or metastatic hormone receptor–positive, human epidermal growth factor receptor 2–negative breast cancer and TAS-102 for metastatic colorectal cancer) to validate the proposed framework; this was followed by a discussion of the results. RESULTS: Eight of the 15 criteria presented to the experts were included in the framework: disease severity, unmet needs, comparative efficacy, comparative safety/tolerability, treatment intent, comparative treatment cost, comparative other medical costs, and quality of evidence. Framework validation in 2 drug cases resulted in similar value scores, although they were based on different contributing criteria and resulted in different clinical recommendations. CONCLUSION: We developed and validated a reflective MCDA framework for the assessment and positioning of oncologic therapies in Spain. Additional work is needed to create a manual for practical decision making in the clinical setting.

A multi-criteria decision analysis on the value of nintedanib for interstitial lung diseases

“…In recent years, there has been an increase in the use of the MCDA in health care, both internationally and nationally, and one very representative example of this is the pilot carried out in Spain, by the Catalan Health Service for the evaluation of orphan drugs (25;26). There are multiple publications in which a specific drug has been considered or evaluated through this methodology, especially in the dermatological (12;27), oncological (14;28) and, closer to the present case, in rare diseases fields (16;29).…”

Shared Decision Making

“…Camps et al [9] Assessment and prioritization of the WHO "best buys" and other recommended interventions for the prevention and control of non-communicable diseases in Iran Bakhtiari et al [5] Benefit and risk of Tripterygium Glycosides Tablets in treatment of rheumatoid arthritis based on multi-criteria decision-making analysis Jiang et al [29] Multiple criteria decision analysis approach to consider therapeutic innovations in the emergency department: The methoxyflurane organizational impact in acute trauma pain Lvovschi et al [39] Feasibility of Measuring Preferences for Chemotherapy Among Early-Stage Breast Cancer Survivors Using a Direct Rank Ordering Multicriteria Decision Analysis Versus a Time Trade-Off Panattoni et al [48] Assessing the Preferences for Criteria in Multi-Criteria Decision Analysis in Treatments for Rare Disease Schey et al [54] 'It takes two to tango': Bridging the gap between country need and vaccine product innovation Archer et al [4] terms, wording and how to conduct MCDA in healthcare settings; implementation of different MCDA techniques as much as possible; mutual comparison of different MCDA methods on the same topic. The most important is to involve in all these researches not only all interested parties rather all possibly involved and impacted parties in decision making process (eg.…”