Skip to main content Accessibility help


  • Úrsula Baños Roldán (a1), Xavier Badia (a2), Jose Antonio Marcos-Rodríguez (a3), Luis de la Cruz-Merino (a4), Jaime Gómez-González (a5), Ana Melcón-de Dios (a6), María de la O Caraballo-Camacho (a7), Jaime Cordero-Ramos (a3), María Dolores Alvarado-Fernández (a3), José Manuel Galiana-Auchel (a8) and Miguel Ángel Calleja-Hernández (a3)...



The aim of this study was to develop and to assess a specific Multi-Criteria Decision Analysis (MCDA) framework to evaluate new drugs in an hospital pharmacy and therapeutics committee (P&TC) setting.


A pilot criteria framework was developed based on the EVIDEM (Evidence and Value: Impact on DEcisionMaking) framework, together with other relevant criteria, and assessed by a group of P&TC's members. The weighting of included criteria was done using a 5-point weighting technique. Two drugs were chosen by evaluation: an orphan-drug for Gaucher disease, and a nonorphan drug for the treatment of inflammatory bowel disease. Evidence matrices were developed, and value contribution of each drug was evaluated by P&TC's members. An agreed final framework was obtained through a discussion between the P&TC's members.


After criteria assessment, the pilot framework included eight quantitative criteria: “disease severity,” “unmet needs,” “comparative efficacy/effectiveness,” “comparative safety/tolerability,” “comparative patient-reported outcomes,” “comparative cost consequences-cost of treatment,” “comparative cost consequences-other medical costs,” and “quality of evidence”; and one contextual criterion: “opportunity costs and affordability.” The most valued criteria were: “comparative safety/tolerability,” “disease severity,” and “comparative efficacy/effectiveness.” When assessing the drugs most valued characteristics of the MCDA were the possibility that all team may contribute to drug assessment by means of scoring the matrices and the discussion to reach a consensus in drug positioning and value decision making.


The reflective MCDA would integrate quantitative and qualitative criteria relevant for a P&TC setting, allowing reflective discussions based on the criteria weighting score.



Hide All

Multidisciplinary Commission Rational Use of Medicine (CMURM) members, Hospital Universitario Virgen Macarena, Sevilla, Spain.

We thank the anonymous referees that helped us with their comments to improve the study



Hide All
1.Hartman, M, Martin, AB, Benson, J, Catlin, A, National Health Expenditure Accounts Team. National health spending in 2011: Overall growth remains low, but some payers and services show signs of acceleration. Health Aff (Millwood). 2013;32:8799.
2.Godman, B, Wettermark, B, van Woerkom, M, et al. Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: Findings and future implications. Front Pharmacol. 2014;5:106.
3.Zhang, Y, Soumerai, SB. Do newer prescription drugs pay for themselves? A reassessment of the evidence. Health Aff (Millwood). 2007;26:880886.
4.Prescrire International. New products and new indications in 2016: A system that favours imitation over the pursuit of real progress. Prescrire Int. 2017;37:132136.
5.Durán-García, E, Santos-Ramos, B, Puigventos-Latorre, F, Ortega, A. Literature review on the structure and operation of Pharmacy and Therapeutics Committees. Int J Clin Pharm. 2011;33:475483.
6.Tyler, LS, Cole, SW, May, JR, et al. ASHP guidelines on the pharmacy and therapeutics committee and the formulary system. Am J Health Syst Pharm. 2008;65:12721283.
7.Jenkings, KN, Barber, N. What constitutes evidence in hospital new drug decision making? Soc Sci Med. 2004;58:17571766.
8.Lozano-Blázquez, A, Calvo-Pita, C, Carbajales-Álvarez, M, et al. Drug assessment by a Pharmacy and Therapeutics committee: From drug selection criteria to use in clinical practice. Ther Clin Risk Manag. 2014;10:527535.
9.Ortega Eslava, A, Puigventós Latorre, F, Santos-Ramos, B, et al. Caracterización y variabilidad de los informes de evaluación de medicamentos en la página web del grupo GENESIS de la SEFH. Farm Hosp. 2011;35:140147.
10.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;188:137156.
11.Marsh, K, Zaiser, E, Orfanos, P, et al. Evaluation of COPD treatments: A multicriteria decision analysis of aclidinium and tiotropium in the United States. Value Health. 2017 Jan;20:132140.
12.Wagner, M, Khoury, H, Bennetts, L, et al. Appraising the holistic value of Lenvatinib for radio-iodine refractory differentiated thyroid cancer: A multi-country study applying pragmatic MCDA. BMC Cancer. 2017;17:272.
13.Goetghebeur, MM, Wagner, M, Khoury, H, et al. Bridging Health Technology Assessment (HTA) and Efficient Health Care Decision Making with Multicriteria Decision Analysis (MCDA). Med Decis Making. 2012;32:376388.
14.EVIDEM | A reflective framework to advance health.
15.Hernández, C, Blázquez, A, Gil, A, Xzzz, Badia. Relative value of Evidem Mcda framework for reflective drug evaluation among therapeutic positioning report evaluators from the Spanish Agency of Medicine. Value Health. 2017;20:A669.
16.Gilabert-Perramon, A, Torrent-Farnell, J, Catalan, A, 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;33:111120.
17.Aguarón, A, Fernández, A, Gimón, A, et al. Patient empowerment for healthcare decision-making assessing oncology innovation through multicriteria decision analysis. Value Health. 2017;20:A451.
18.Friedmann, C, Levy, P, Hensel, P, Hiligsmann, M. Using multi-criteria decision analysis to appraise orphan drugs: A systematic review. Expert Rev Pharmacoecon Outcomes Res. 2018;18:135146.
19.Bentley, TGK, Cohen, JT, Elkin, EB, et al. Validity and reliability of value assessment frameworks for new cancer drugs. Value Health. 2017;20:200205.
20.Wagner, M, Samaha, D, Khoury, H, et al. Development of a framework based on reflective MCDA to support patient-clinician shared decision-making: The case of the management of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NET) in the United States. Adv Ther. 2018;35:8199.
21.Schey, C, Krabbe, PFM, Postma, MJ, Connolly, MP. Multi-criteria decision analysis (MCDA): Testing a proposed MCDA framework for orphan drugs. Orphanet J Rare Dis. 2017;12:10.
22.Marra, LP, Araújo, VE, Silva, TBC, et al. Clinical effectiveness and safety of analog glargine in type 1 diabetes: A systematic review and meta-analysis. Diabetes Ther. 2016;7:241258.
23.Badia, X, Poveda-Andrés, JL, Merino-Montero, S. Análisis descriptivo de los criterios usados en los informes de evaluación de fármacos en España. Rev Española Econ la Salud. 2017;12:180191.
24.Terkola, R, Antoñanzas, F, Postma, M. Stakeholder opinions on value in healthcare. Eur J Hosp Pharm. 2017 Oct;ejhpharm-2017-001295.
25.LINX Reflux Management System - dispositivo medico impiantabile attivo per il trattamento della malattia da reflusso gastro-esofageo (MRGE). 2013.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed