MULTI-CRITERIA DECISION ANALYSIS OF PHARMACOLOGICAL MAINTENANCE TREATMENT OPTIONS IN BIPOLAR DISORDER: EVALUATION OF AN EXPEDITE APPROACH

Purpose: The primary purpose was to evaluate the value for individual patients and the feasibility of performing an expedite comparative effectiveness review including an expert network meta-analysis and estimates of treatment burden associated with the treatment options, compared to producing a full systematic review and network meta-analysis. The secondary purpose was to estimate the effect on the ranking of treatment options of using the weightings of the criteria from individual patients, instead of average or equal weights, in the analysis.

Method(s): To populate a decision matrix with ratings for all criteria known to be important to patients, on all relevant options, we performed an expedite comparative effectiveness review and network meta-analysis, an expert network meta-analysis, and a survey about treatment burden among patients. Relative importance weightings for the criteria were obtained from individual patients. We used these weightings to calculate the expected values for each of the options, to produce rankings of the options, and to estimate the incremental gain of the methods used, and their effects on the ranking of options, compared to a systematic review and network meta-analysis.

Result(s): It was feasible to populate a decision matrix addressing all main criteria empirically found to be important to patients, using expedite methods. The systematic review and network meta-analysis produced modestly more comprehensive and reliable data than the expedite, comparative effectiveness review, but the rank order of the options and their expected values were relatively similar for the two approaches. Adding the expert meta-analysis ratings to the decision analysis affected the rank order considerably, but the reliability of these data was low. Including treatment burden in the analysis, and applying weightings from individual patients instead of average or equal weights all significantly affected the rank order of the treatment options and their expected values.

Conclusion(s): Expedite comparative effectiveness reviews including network meta-analysis might be an alternative to full systematic reviews and meta-analyses. To foster patient-centred care, evaluations of the value of different treatments options, and the value of gold standard systematic reviews compared to expedite methods, it should be considered to use the relative importance weightings from individual patients, rather than average or equal weights.