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Can multi-criteria decision analysis (MCDA) be implemented into real-world drug decision-making processes? A Canadian provincial experience

Published online by Cambridge University Press:  07 August 2020

Tracey-Lea Laba Open the ORCID record for Tracey-Lea Laba [Opens in a new window] ,
Bashir Jiwani ,
Robert Crossland  and
Craig Mitton
Tracey-Lea Laba*
Affiliation:
The University of British Columbia, Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada The Centre for Health Economics Research and Evaluation, Business School, The University of Technology, Sydney, Australia
Bashir Jiwani
Affiliation:
Fraser Health, Ethics and Diversity Services, Surrey, Canada
Craig Mitton
Affiliation:
The University of British Columbia, Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada
*
Author for correspondence: Tracey-Lea Laba, E-mail: tracey.laba@chere.uts.edu.au
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Abstract

Objective

To describe the implementation of multi-criteria decision analysis (MCDA) into a Canadian public drug reimbursement decision-making process, identifying the aspects of the MCDA approach, and the context that promoted uptake.

Methods

Narrative summary of case study describing the how, when, and why of implementing MCDA.

Results

Faced with a fixed budget, a pipeline of expensive but potentially valuable drugs, and potential delays to drug decision making, the Ministry of Health (i.e., decision makers) and its independent expert advisory committee (IAB) sought alternative values-based decision processes. MCDA was considered highly compatible with current processes, but the ability as a stand-alone intervention to address issues of opportunity cost was unclear. The IAB nevertheless collaboratively voted to implement an externally developed MCDA with support from decision makers. After several months of engagement and piloting, implementation was rapid and leveraged strong pre-existing formal and informal communication networks. The IAB as a whole rates new submissions which serves as an input into the deliberative process.

Conclusions

MCDA can be a highly adaptable approach that can be implemented into a functioning drug reimbursement setting when facilitated by (i) a truly limited budget; (ii) a shared vision for change by end-users and decision makers; (iii) using pre-existing deliberative processes; and (iv) viewing the approach as a decision framework rather than the decision (when appropriate). Given the current limitations of MCDA, implementing an academically imperfect tool first and evaluating later reflects a practical solution to real-time fiscal constraints and impending delays to drug approvals that may be faced by decision makers.

Keywords

Multi-criteria decision analysisPharmaceutical policyDecision makingMCDA
Type
Policy
Information
International Journal of Technology Assessment in Health Care , Volume 36 , Issue 4 , August 2020 , pp. 434 - 439
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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