Using MCDA as a Decision Aid in Health Technology Appraisal for Coverage Decisions: Opportunities, Challenges and Unresolved Questions

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)

“…In addition, this would not allow for an appropriate consideration of the opportunity costs of the coverage decision [ 21 ]. Instead, costs can be considered separately to explicitly trade-off (incremental) benefits generated by a new treatment against its (incremental) costs (for a discussion about this issue see Garau and Devlin [ 22 ]). When decision makers face a fixed budget constraint, an aggregate measure of benefit (similar to the score presented in Fig.…”

“…On the other hand, for repeated reimbursement or HTA decisions affecting a fixed budget, there is a need to define the ‘hurdle for adoption’ [ 24 ]; in other words, the incremental cost per value score to compare against the cost per value score of individual interventions to understand whether they are good value for money. However, given the methodological issues in defining and estimating the opportunity cost of HTA decisions [ 25 – 28 ] and the role of regional (as opposed to national) jurisdictions in the management of the health budget, there might be a need to develop new approaches to ensure efficient decision making [ 22 ].…”

Multi-Criteria decision analysis in healthcare its usefulness and limitations for decision making

“…From a conceptual point of view, the vast majority of economic evaluations carried out neither incorporate criteria of equity (one year of life or a QALY are valued independently of the disease, the age and the group of patients), nor claim to be, at least from an extra-welfarist approach, the only decision criterion with a metric based solely on the ICER. The very logic of using cost per QALY relies on extra-welfarist theories, and this approach is the one that provides theoretical bases for the inclusion of other criteria in the MCDA (Culyer, 1991;Garau and Devlin, 2017). The main justification, beyond the specific limitations of the QALY -which do not need to be reviewed in detail here - Nord, 2017), is that the ICER corresponds only to the criterion of efficiency Drummond et al, 2015).…”

“…In practice, decisions about the allocation of health resources of HTAs take into account, in addition to comparative efficacy and safety, the ICER and the budgetary impact, five groups of 'other' factors: a) the incidence, prevalence and severity of the illness; b) the affected population group; c) the availability of therapeutic alternatives; d) the quality of the available evidence; and e) the degree of technological innovation Regier and Peacok, 2017;Garau and Devlin, 2017). This list of factors could be somewhat more…”

Does MCDA Trump CEA?

“…This is an implication generally understood by CEA practitioners [33]. CEA analysts also recognise that efficiency is not the sole criterion for making healthcare investments, that there can be conflict between criteria, including cost-effectiveness, and that double counting can be a major distortion [8].…”