تحلیل تصمیم گیری چند معیاره برای ارزیابی فناوری سلامت

Objectives Multicriteria decision analysis (MCDA) has been suggested by some researchers as a method to capture the benefits beyond quality adjusted life-years in a transparent and consistent manner. The objectives of this article were to analyze the possible application of MCDA approaches in health technology assessment and to describe their relative advantages and disadvantages. Methods This article begins with an introduction to the most common types of MCDA models and a critical review of state-of-the-art methods for incorporating multiple criteria in health technology assessment. An overview of MCDA is provided and is compared against the current UK National Institute for Health and Clinical Excellence health technology appraisal process. A generic MCDA modeling approach is described, and the different MCDA modeling approaches are applied to a hypothetical case study. Results A comparison of the different MCDA approaches is provided, and the generic issues that need consideration before the application of MCDA in health technology assessment are examined. Conclusions There are general practical issues that might arise from using an MCDA approach, and it is suggested that appropriate care be taken to ensure the success of MCDA techniques in the appraisal process.

In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) makes recommendations to the National Health Service after assessing new and existing medical technologies. The current practice of NICE health technology appraisals is based on the incremental cost-effectiveness ratio (ICER), that is, the incremental cost per quality-adjusted life-year (QALY) gained by recipients of treatment. Even though NICE considers other criteria (e.g., severity and life saving) along with ICERs, there is concern that this approach may fail to capture other important sources of value [1], [2] and [3]. In recognition of this issue, NICE commissioned Professor Sir Ian Kennedy to carry out a study on the relationship between innovation and the value of the technologies [4]. Also, recent developments such as the Patient Protection and Affordable Care Act in America [5] and the UK Department of Health's decision to use value-based pricing [6] indicate a paradigm shift toward transparency in using other criteria along with the traditional cost-effectiveness (C/E) analysis. Multicriteria decision analysis (MCDA) methods can support decision makers faced with evaluating alternatives by taking into account multiple criteria in an explicit manner [7]. They provide a structured and transparent approach to identify a preferred alternative by clear consideration of the relative importance of the different criteria and the performance of the alternatives on the criteria. In fact, a number of pharmaceutical drug manufacturers recommended the use of MCDA (in their submissions to Professor Sir Ian Kennedy) but recognized that further research is needed before their implementation in the health technology appraisal process. The main aspects of any MCDA method are 1) the alternatives to be appraised, 2) the criteria (or attributes) against which the alternatives are appraised, 3) scores that reflect the value of an alternative's expected performance on the criteria, and 4) criteria weights that measure the relative importance of each criterion as compared with others. MCDA approaches can be classified broadly into three categories: value measurement models, outranking models, and goal, aspiration, or reference-level models [7]. Figure 1 shows these three methods.

An overview of the MCDA process is provided and is identified to be similar to the existing NICE appraisal process but with the addition of a formal mathematical approach to decision making. The main MCDA modeling approaches are applied to a hypothetical case study, and their potential strengths and weaknesses are outlined. The potential users need to understand the general practical issues that might arise from using an MCDA approach in the HTA process and choose an appropriate MCDA method to ensure the success of MCDA techniques in the appraisal process. Source of financial support: This research has received financial support from the NICE Decision Support Unit, but NICE had no responsibility or control over the content of this article.