A MULTI CRITERIA DECISION ANALYSIS-BASED APPROACH TO HEALTH TECHNOLOGY ASSESSMENT

Purpose:

To develop a Multi Criteria Decision Analysis (MCDA) methodology for the purpose of evaluating new drugs for reimbursement by health system, which addresses current shortcomings in traditional health economics based approaches.

Method(s):

Two approaches are assessed. The first is based upon extending the traditional net-benefit approach to include multiple criteria in the benefit portion of the assessment. This requires setting a threshold parameter defining the opportunity cost of a unit of full health. The second approach uses MCDA within a Bayesian statistical decision making framework and ranking theory. An opportunity cost threshold is not specified but decisions are made using a loss function and probabilities of expected ranks. The methods are applied to past reimbursement recommendations made by the National Centre for Pharmacoeconomics in Ireland.

Result(s):

Both methods can account for discrepancies between recommendations and decisions and the outputs of traditional cost-effectiveness models. The statistical decision making approach does not require the specification of the cost of unit of health but requires correct specification of the loss function.

Conclusion(s):

An MCDA based approach to HTA addresses some of the theoretical and practical shortcomings of traditional cost-effectiveness analysis by accounting for multiple criteria which define the societal utility and adhering to Bayesian decision theory.