Multicriteria Decision Analysis to Support Health Technology Assessment Agencies: Benefits, Limitations, and the Way Forward

Baltussen, Rob; Marsh, Kevin; Thokala, Praveen; Diaby, Vakaramoko; Castro, Héctor; Cleemput, Irina; Garau, Martina; Искров, Георги; Olyaeemanesh, Alireza; Mirelman, Andrew; Mobinizadeh, Mohammadreza; Morton, Alec; Tringali, Michele; Til, Janine Astrid van; Valentim, Joice; Wagner, Monika; Youngkong, Sitaporn; Zah, V.; Toll, Agnes; Jansen, Maarten; Bijlmakers, Leon; Oortwijn, Wija; Broekhuizen, Henk

doi:10.1016/j.jval.2019.06.014

Cited by 118 publications

(156 citation statements)

References 34 publications

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“…Specifically, we have added guidance on stakeholder participation 20 as well as guidance on how to use MCDA for HTA agencies, based on a recent consensus statement among more than 20 experts in the field. 21…”

Section: Discussionmentioning

confidence: 99%

Use of Evidence-Informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe

Oortwijn¹,

Jansen²,

Baltussen³

2019

Int J Health Policy Manag

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Background: Evidence-informed deliberative processes (EDPs) were recently introduced to guide health technology assessment (HTA) agencies to improve their processes towards more legitimate decision-making. The EDP framework provides guidance that covers the HTA process, ie, contextual factors, installation of an appraisal committee, selecting health technologies and criteria, assessment, appraisal, and communication and appeal. The aims of this study were to identify the level of use of EDPs by HTA agencies, identify their needs for guidance, and to learn about best practices. Methods: A questionnaire for an online survey was developed based on the EDP framework, consisting of elements that reflect each part of the framework. The survey was sent to members of the International Network of Agencies for Health Technology Assessment (INAHTA). Two weeks following the invitation, a reminder was sent. The data collection took place between September-December 2018. Results: Contact persons from 27 member agencies filled out the survey (response rate: 54%), of which 25 completed all questions. We found that contextual factors to support HTA development and the critical elements regarding conducting and reporting on HTA are overall in place. Respondents indicated that guidance was needed for specific elements related to selecting technologies and criteria, appraisal, and communication and appeal. With regard to best practices, the Canadian Agency for Drugs and Technologies and the National Institute for Health and Care Excellence (NICE, UK) were most often mentioned. Conclusion: This is the first survey among HTA agencies regarding the use of EDPs and provides useful information for further developing a practical guide for HTA agencies around the globe. The results could support HTA agencies in improving their processes towards more legitimate decision-making, as they could serve as a baseline measurement for future monitoring and evaluation.

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Section: Discussionmentioning

confidence: 99%

Use of Evidence-Informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe

Oortwijn¹,

Jansen²,

Baltussen³

2019

Int J Health Policy Manag

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“…Baltussen et al note that all three approaches to MCDA can improve the transparency of priority setting by providing explicit criteria against which health interventions are evaluated (4). Furthermore, they add that quantitative MCDA can enhance transparency compared to qualitative MCDA when the numerical weights and scores for these criteria and the mathematical aggregation function are explicitly reported to the public.…”

Section: On Transparency: More Than Disclosing Methods and Scoresmentioning

confidence: 99%

“…Finally, MCDA appraisal committees may simply overlook or shortchange deliberation when it is the last step of a long and complex process. Indeed, Baltussen et al found that only a minority of quantitative MCDA studies reported engaging in deliberation at all (4). Thus, to better promote the quality and transparency of appraisals, deliberation should be given a much more prominent role in appraisals through the adoption of qualitative MCDA.…”

Section: On Transparency: More Than Disclosing Methods and Scoresmentioning

confidence: 99%

Beyond the numbers: a critique of quantitative multi-criteria decision analysis

DiStefano

Krubiner

2020

Int J Technol Assess Health Care

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When setting priorities for health, there is broad agreement that a range of social values and ethical principles beyond clinical and cost-effectiveness matter, but exactly how health technology assessment (HTA) should account for a broader set of criteria remains an area of ongoing debate. In light of this, we welcome a recent review paper by Baltussen et al. evaluating the potential of different multi-criteria decision analysis (MCDA) approaches to enable HTA agencies to incorporate a broader set of values in their appraisals. The authors describe three approaches to MCDA—qualitative MCDA, quantitative MCDA, and MCDA with decision rules—laying out their relative advantages and disadvantages and providing recommendations for how they can best be implemented. While we endorse many of the authors' assessments and conclusions, including the critical role of deliberation in any MCDA approach and the undertaking of qualitative MCDA at a minimum, we take a stronger position regarding the flaws of quantitative MCDA and strongly caution against it. We find quantitative MCDA antithetical to at least two of the ways MCDA is intended to improve HTA recommendations: (i) enhancing quality and (ii) promoting transparency. Quantitative MCDA may mask the complex tradeoffs that exist within and between decision criteria and remain generally inaccessible to those who are not well-versed in its technical methods of appraisal. We advocate for a predominantly qualitative approach to MCDA appraisal centered around deliberation and supplemented with decision aids to help account for health opportunity costs.

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“…Rather, MCDA should be a part of the broader domain of priority setting and resource allocation decisions where considerations of budget and opportunity cost occur concurrently. As such it may be helpful to distinguish between "qualitative" MCDA and "quantitative" MCDA (25). The former is described as a deliberative process that embeds the use of MCDA within larger discussions about overall affordability and value for money relative to the broader portfolio of investments.…”

Section: The Rise Of Multi-criteria Decision Analysis (Mcda) In Drug mentioning

confidence: 99%

Can multi-criteria decision analysis (MCDA) be implemented into real-world drug decision-making processes? A Canadian provincial experience

Laba

Jiwani

Crossland³

et al. 2020

Int J Technol Assess Health Care

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Objective To describe the implementation of multi-criteria decision analysis (MCDA) into a Canadian public drug reimbursement decision-making process, identifying the aspects of the MCDA approach, and the context that promoted uptake. Methods Narrative summary of case study describing the how, when, and why of implementing MCDA. Results Faced with a fixed budget, a pipeline of expensive but potentially valuable drugs, and potential delays to drug decision making, the Ministry of Health (i.e., decision makers) and its independent expert advisory committee (IAB) sought alternative values-based decision processes. MCDA was considered highly compatible with current processes, but the ability as a stand-alone intervention to address issues of opportunity cost was unclear. The IAB nevertheless collaboratively voted to implement an externally developed MCDA with support from decision makers. After several months of engagement and piloting, implementation was rapid and leveraged strong pre-existing formal and informal communication networks. The IAB as a whole rates new submissions which serves as an input into the deliberative process. Conclusions MCDA can be a highly adaptable approach that can be implemented into a functioning drug reimbursement setting when facilitated by (i) a truly limited budget; (ii) a shared vision for change by end-users and decision makers; (iii) using pre-existing deliberative processes; and (iv) viewing the approach as a decision framework rather than the decision (when appropriate). Given the current limitations of MCDA, implementing an academically imperfect tool first and evaluating later reflects a practical solution to real-time fiscal constraints and impending delays to drug approvals that may be faced by decision makers.

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Multicriteria Decision Analysis to Support Health Technology Assessment Agencies: Benefits, Limitations, and the Way Forward

Cited by 118 publications

References 34 publications

Use of Evidence-Informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe

Use of Evidence-Informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe

Beyond the numbers: a critique of quantitative multi-criteria decision analysis

Can multi-criteria decision analysis (MCDA) be implemented into real-world drug decision-making processes? A Canadian provincial experience

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