Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-26T04:20:52.119Z Has data issue: false hasContentIssue false
  • English
  • Français

Multiple criteria decision analysis for medicine reimbursement in the Lebanese context

Published online by Cambridge University Press:  21 June 2021

Soumana C. Nasser Open the ORCID record for Soumana C. Nasser [Opens in a new window] ,
Sandrine Sarine Aderian ,
Hanane Khoury  and
Dima Samaha
Soumana C. Nasser*
Affiliation:
Lebanese American University, School of Pharmacy, P.O.Box 36S, Byblos, Lebanon
Sandrine Sarine Aderian
Affiliation:
Lebanese American University, School of Pharmacy, P.O.Box 36S, Byblos, Lebanon
Hanane Khoury
Affiliation:
Certara Evidence & Access, Montreal, Canada
Dima Samaha
Affiliation:
Certara Evidence & Access, London, UK
*
Author for correspondence: Soumana C. Nasser, E-mail: soumana.nasser@lau.edu.lb
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The objective of this exploratory analysis is to reflect and discuss which criteria of multiple criteria decision analysis (MCDA) would be relevant as part of value determination when appraising healthcare interventions in the Lebanese context.

Methods

A workshop was conducted as part of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Lebanon Chapter and included the two frameworks: Evidence and Value: Impact on Decision Making (EVIDEM) and Advance Value Framework. Thirty-seven participants expressed their individual preferences through a qualitative and a quantitative exercise.

Results

In the qualitative analysis of both frameworks, participants unanimously agreed on the relevance of comparative efficacy, safety, and impact of medical costs. In EVIDEM, disease severity and unmet needs were also considered to be important criteria by more than 90 percent of the participants. In the quantitative analysis of both frameworks, disease severity ranked first (a mean normalized weight of .1 in EVIDEM and .27 in Advance Value Framework), followed by the size of the population (.09), the type of therapeutic benefit at the patient level (.09) and population level (.08), and the efficacy (.07) in EVIDEM. In the Advance Value Framework, the combined unmet need/disease severity criteria were followed by direct and meaningful end points (.15), safety (.12), contraindications (.08), and indirect surrogate end points (.07).

Conclusions

The results were concordant with those reported in countries that have conducted similar surveys such as France, Italy, and Spain. The MCDA methodology could be used as a cornerstone to enhance evidence-based discussions among Lebanese stakeholders involved in evaluation and decision-making purposes.

Keywords

MCDADecision makingEVIDEMAdvance value framework
Type
Policy
Information
International Journal of Technology Assessment in Health Care , Volume 37 , Issue 1 , 2021 , e69
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Angelis, A, Lange, A, Kanavos, P. Using health technology assessment to assess the value of new medicines: Results of a systematic review and expert consultation across eight European countries. Eur J Health Econ. 2018;19:123–52.CrossRefGoogle ScholarPubMed
Walker, A. Challenges in using MCDA for reimbursement decisions on new medicines? Value Health. 2016;19:123–4.CrossRefGoogle ScholarPubMed
Oortwijn, W, Klein, P. Addressing health system values in health technology assessment: The use of evidence-informed deliberative processes. Int J Technol Assess Health Care. 2019:1–3.Google ScholarPubMed
Marsh, K, Thokala, P, Youngkong, S, Chalkidou, K. Incorporating MCDA into HTA: Challenges and potential solutions, with a focus on lower income settings. Cost Eff Resour Alloc. 2018;16:43.CrossRefGoogle ScholarPubMed
Angelis, A, Kanavos, P. Multiple criteria decision analysis (MCDA) for evaluating new medicines in health technology assessment and beyond: The advance value framework. Soc Sci Med. 2017;188:137–56.CrossRefGoogle ScholarPubMed
Wagner, M, Samaha, D, Cuervo, J, Patel, H, Martinez, M, O'Neil, WM, et al. Applying reflective multicriteria decision analysis (MCDA) to patient-clinician shared decision-making on the management of gastroenteropancreatic neuroendocrine tumors (GEP-NET) in the Spanish context. Adv Ther. 2018;35:1215–31.CrossRefGoogle ScholarPubMed
Non Communicable Diseases Prevention and Control Plan (NCD-PCP) Lebanon 2016-2020. Lebanon: Republic of Lebanon Ministry of Public Health. 2016 [cited 2019 Dec 22]. Available from: https://www.moph.gov.lb/en/view/3691/non-communicable-diseases-prevention-and-control-plan-ncd-pcp-lebanon-2016-2020.Google Scholar
The World Bank in Lebanon. The World Bank. 2018 [cited 2019 Dec 22]. Available from: https://www.worldbank.org/en/country/lebanon.Google Scholar
Ammar, W, Kdouh, O, Hammoud, R, Hamadeh, R, Harb, H, Ammar, Z, et al. Health system resilience: Lebanon and the Syrian refugee crisis. J Glob Health. 2016;6:020704.CrossRefGoogle ScholarPubMed
Daou R. BMI Pharmaceuticals and Healthcare Report 2018. 2018 [cited 2019 Dec 22]. Available from: https://blog.blominvestbank.com/27177/bmi-pharmaceuticals-healthcare-lebanon-2018/.Google Scholar
Noncommunicable Diseases Country Profiles 2018. World Health Organization. 2018 [cited 2019 Dec 22]. Available from: https://www.who.int/nmh/publications/ncd-profiles-2018/en/.Google Scholar
Maskineh, C, Nasser, SC. Managed entry agreements for pharmaceutical products in Middle East and North African countries: Payer and manufacturer experience and outlook. Value Health Reg Issues. 2018;16:33–8.CrossRefGoogle ScholarPubMed
2019 Top 10 Heor Trends. ISPOR. 2019 [cited 2019 Dec 22]. Available from: https://www.ispor.org/docs/default-source/about-ispor/ispor-top-10-heor-trends-2019_00120190107_2-2.pdf?sfvrsn=c8d9948b_0.Google Scholar
Goetghebeur, MM, Wagner, M, Samaha, D, O'Neil, W, Badgley, D, Castro-Jaramillo, H, et al. Exploring values of health technology assessment agencies using reflective multicriteria and rare disease case. Int J Technol Assess Health Care. 2017;33:504–20.CrossRefGoogle ScholarPubMed
Goetghebeur, MM, Wagner, M, Khoury, H, Levitt, RJ, Erickson, LJ, Rindress, D. Evidence and value: Impact on decision making–the EVIDEM framework and potential applications. BMC Health Serv Res. 2008;8:1–16.CrossRefGoogle Scholar
Angelis, A, Linch, M, Montibeller, G, Molina-Lopez, T, Zawada, A, Orzel, K, et al. Multiple criteria decision analysis for HTA across four EU member states: Piloting the advance value framework. Soc Sci Med. 2020;246:112595.CrossRefGoogle ScholarPubMed
Baran-Kooiker, A, Czech, M, Kooiker, C. Multi-criteria decision analysis (MCDA) models in health technology assessment of orphan drugs - A systematic literature review. Next steps in methodology development? Front Public Health. 2018;6:287.CrossRefGoogle ScholarPubMed
Godman, B, Bucsics, A, Vella Bonanno, P, Oortwijn, W, Rothe, CC, Ferrario, A, et al. Barriers for access to new medicines: Searching for the balance between rising costs and limited budgets. Front Public Health. 2018;6:328.CrossRefGoogle ScholarPubMed
Lasalvia, P, Prieto-Pinto, L, Moreno, M, Castrillón, J, Romano, G, Garzón-Orjuela, N, et al. International experiences in multicriteria decision analysis (MCDA) for evaluating orphan drugs: A scoping review. Expert Rev Pharmacoecon Outcomes Res. 2019;19:409–20.CrossRefGoogle ScholarPubMed
Gilabert-Perramon, A, Torrent-Farnell, J, Catalan, A, Prat, A, Fontanet, M, Puig-Peiró, R, et al. Drug evaluation and decision making in Catalonia: Development and validation of a methodological framework based on multi-criteria decision analysis (MCDA) for orphan drugs. Int J Technol Assess Health Care. 2017;33:111–20.CrossRefGoogle ScholarPubMed
Iskrov, G, Stefanov, R. Criteria for drug reimbursement decision-making: An emerging public health challenge in Bulgaria. Balkan Med J. 2016;33:27–35.CrossRefGoogle ScholarPubMed
Vreman, RA, Heikkinen, I, Schuurman, A, Sapede, C, Garcia, JL, Hedberg, N, et al. Unmet medical need: An introduction to definitions and stakeholder perceptions. Value Health. 2019;22:1275–82.CrossRefGoogle ScholarPubMed
Marsh, KD, Sculpher, M, Caro, JJ, Tervonen, T. The use of MCDA in HTA: Great potential, but more effort needed. Value Health. 2018;21:394–7.CrossRefGoogle ScholarPubMed
Németh, B, Molnár, A, Bozóki, S, Wijaya, K, Inotai, A, Campbell, JD, et al. Comparison of weighting methods used in multicriteria decision analysis frameworks in healthcare with focus on low- and middle-income countries. J Comp Eff Res. 2019;8:195–204.CrossRefGoogle ScholarPubMed
Keeney, RL. Common mistakes in making value trade-offs. Oper Res. 2002;50:935–45.CrossRefGoogle Scholar
Keeney, RL, Raiffa, H. Decisions with multiple objectives–preferences and value tradeoffs. Cambridge & New York: Cambridge University Press; 1993.CrossRefGoogle Scholar
Stratil, JM, Baltussen, R, Scheel, I, Nacken, A, Rehfuess, EA. Development of the WHO-INTEGRATE evidence-to-decision framework: An overview of systematic reviews of decision criteria for health decision-making. Cost Eff Resour Alloc. 2020;18:8.CrossRefGoogle ScholarPubMed
Thokala, P, Devlin, N, Marsh, K, Baltussen, R, Boysen, M, Kalo, Z, et al. Multiple criteria decision analysis for health care decision making – An introduction: Report 1 of the ISPOR MCDA emerging good practices task force. Value Health. 2016;19:1–13.CrossRefGoogle ScholarPubMed
Baltussen, R, Jansen, MPM, Bijlmakers, L, Grutters, J, Kluytmans, A, Reuzel, RP, et al. Value assessment frameworks for HTA agencies: The organization of evidence-informed deliberative processes. Value Health. 2017;20:256–60.CrossRefGoogle ScholarPubMed
Baltussen, R, Marsh, K, Thokala, P, Diaby, V, Castro, H, Cleemput, I, et al. Multicriteria decision analysis to support health technology assessment agencies: Benefits, limitations, and the way forward. Value Health. 2019;22:1283–8.CrossRefGoogle ScholarPubMed
Supplementary material: File

Nasser et al. supplementary material

Nasser et al. supplementary material

Download Nasser et al. supplementary material(File)
File 18.1 KB