RT Journal Article
T1 Multiple Criteria Decision Analysis for HTA across four EU Member States: Piloting the Advance Value Framework.
A1 Angelis, A
A1 Linch, M
A1 Montibeller, G
A1 Molina-Lopez, T
A1 Zawada, A
A1 Orzel, K
A1 Arickx, F
A1 Espin, J
A1 Kanavos, P
K1 Advance Value Framework (AVF)
K1 Decision conference
K1 Decision making
K1 Health Technology Assessment (HTA)
K1 Multiple Criteria Decision Analysis (MCDA)
K1 Oncology
K1 Pharmaceuticals
K1 Value assessment
AB Multiple Criteria Decision Analysis (MCDA) has emerged as a methodology for Health Technology Assessment (HTA). However, limited empirical evidence is available on its use by decision-makers; where available, it only comes from single-setting exercises, while cross-country comparative studies are unavailable. This study applies the Advance Value Framework (AVF), an MCDA methodology for HTA based on multi-attribute value theory, through a series of case studies with decision-makers in four countries, to explore its feasibility and compare decision-makers' value preferences and results. The AVF was applied in the evaluation of three drugs for metastatic, castrate resistant, prostate cancer (abiraterone, cabazitaxel and enzalutamide) in the post-chemotherapy indication. Decision conferences were organised in four European countries in collaboration with their HTA or health insurance organisations by involving relevant assessors and experts: Sweden (TLV), Andalusia/Spain (AETSA), Poland (AOTMiT) and Belgium (INAMI-RIZIV). Participants' value preferences, including performance scoring and criteria weighting, were elicited through a facilitated decision-analysis modelling approach using the MACBETH technique. Between 6 and 11 criteria were included in each jurisdiction's value model, allocated across four criteria domains; Therapeutic Benefit criteria consistently ranked first in relative importance across all countries. Consistent drug rankings were observed in all settings, with enzalutamide generating the highest overall weighted preference value (WPV) score, followed by abiraterone and cabazitaxel. Dividing drugs' overall WPV scores by their costs produced the lowest "cost per unit of value" for enzalutamide, followed by abiraterone and cabazitaxel. These results come in contrast with the actual country HTA recommendations and pricing decisions. Overall, although some differences in value preferences were observed between countries, drug rankings remained the same. The MCDA methodology employed could act as a decision support tool in HTA, due to the transparency in the construction of value preferences in a collaborative manner.
PB BioMed Central Ltd.
YR 2019
FD 2019-10-10
LK http://hdl.handle.net/10668/14876
UL http://hdl.handle.net/10668/14876
LA en
NO 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 Feb;246:112595.
NO This paper has been conducted in the context of the Advance-HTA project, which has received funding from the European Commission's FP-7 Research Programme (grant agreement number: 305983). The views reflected in the paper do not represent the views of the European Commission. M.L. receives funding from the National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, and CRUK UCL Experimental Cancer Medicine Centre. M.L. has received research funding from Bristol- Myers Squibb (BMS), AstraZeneca/MedImmune, Sanofi and Astellas and has received consulting fees from Janssen Pharmaceuticals, BioNTech and BMS.We are grateful to Carlos Bana e Costa, Larry Phillips and Douglas Lundin for constructive feedback and suggestions on earlier versions of the paper. This research was made possible through the participation of a number of experts and stakeholders in four decision conferences that took place in collaboration with the Swedish Dental and Pharmaceutical Benefits Agency (TLV) in Stockholm, the Andalusian Health Technology Assessment Agency (AETSA) in Seville, the Polish Agency for Health Technology Assessment and Tariff System (AOTMiT) in Warsaw, and the Belgian Health Insurance Fund (INAMI-RIZIV) in Brussels. We are indebted to all participants for their valuable time and involvement. Thanks are also due to Olina Efthymiadou and Erica Visintin for valuable research assistance with drug costs and innovation spill-over effects calculations. Finally, we would like to thank all partners of the Advance-HTA consortium for their feedback throughout the project. All outstanding errors are our own.
DS RISalud
RD Apr 10, 2025