W17: Understanding and modeling business decisions in market access and reimbursement using multi-criteria decision analysis techniques

Transcription

1 W17: Understanding and modeling business decisions in market access and reimbursement using multi-criteria decision analysis techniques ISPOR 19 th International Meeting Montreal Tuesday June 3 rd 2014, 5-6 PM 2013 Evidera. All Rights Reserved. 2 1

2 Business decisions made by industry Which molecules should we invest in? Which patient group should we target? Which evidence should we gather? Where and how should the product be launched? What is the best possible price? Source: Ijzerman and Steuten (2011) 3 Objectives and overview Objective To introduce MCDA as a method to support business decisions To discuss the opportunities for and challenges to adopting MCDA to support these decisions Overview Tereza Lanitis (Evidera, UK): Introduction to MCDA in healthcare, example of MCDA being used to support business decisions Maarten IJzerman (University of Twente, the Netherlands): The methodological issues raised by the use of MCDA to support business decisions Ansgar Hebborn (Roche, Switzerland): Companies internal decision making, and the challenges adopting MCDA Discussion 4 2

3 Audience survey 5 Introduction to Multiple Criteria Decision Analysis (MCDA) and its use in health-care Tereza Lanitis, MSc Kevin Marsh, PhD 2013 Evidera. All Rights Reserved. 3

4 Overview Overview of MCDA Use of MCDA in health care Use of MCDA to support business decision making 7 What is MCDA? Multi-criteria decision analysis supports decision makers faced with evaluating alternatives taking into multiple, and often conflictive, criteria. A methodology for combining multiple criteria into one overall appraisal. Converts all metrics into the common currency of preference value Source: Baltussen et al

5 Type of MCDA models Value measurement models Weighted sum approach PBMA, AHP, MAUT, etc Outranking Direct comparison of alternatives ELECTRE, PROMETHEE, etc Goal programming multi-objective optimisation, LP, etc 9 Uniform steps in MCDA Common steps (for instance, CLG, 2009) Measure criteria Identify criteria Weight criteria Establish the decision context Identify criteria Weight criteria Measure criteria Overall value message Analysis, sensitivity analysis Dissemination 10 5

6 MCDA is generating interest from payers and regulators world-wide CADTH: Has acknowledged the value of MCDA in HTA IoM: Developed an MCDA to prioritise vaccines CvZ: Investigating on the role of MCDA in HTA NICE: Consulted on the role of MCDA. Develop new orphan drug process IQWiG: Piloting DCE and AHP for economic evaluation Thailand: Applied MCDA to inform coverage decisions EMA: Piloted MCDA for BRA 11 Use of MCDA in Healthcare is on the Rise Source: Diaby et al.,

7 MCDA has Multiple Uses in valuation of health care interventions Coverage / reimbursement Prescription Authorization Research Interest Not reported 2% 7% 12% 56% 22% Source: Marsh et al Participant views of MCDA Systematic, transparent and consistent Facilitating knowledge transfer Challenging to interpret the value estimates Improve the quality of the discussion Use of subjective estimates Improved the transparency Supporting systematic consideration of a broad range of criteria Force people to think Improved understanding Cognitive burden Source: Marsh et al. (2014) 7

8 Can MCDA aid in strategic decision making? Decision problem and challenges Billions of dollars invested in medical product development R&D spending versus stricter control of healthcare budgets Pressure to maximize the revenues of these investments Uncertainty in sales projections Uncertainty in probability of success Availability of multiple alternatives for investments Conflicting and multiple objectives in terms of benefits and risks Multiple stakeholders with different agendas 15 MCDA in strategic decision making A portfolio optimization example Project prioritisation: the Allergan experience Use of MCDA to review investments structured within five areas representing major products of the company and inform portfolio decisions Gain an understanding of value-for-money associated with projects Efficiency frontier approach Value and benefit of projects to formally incorporate: Uncertainty around sales projections Probability of success Non-monetary values of the company: o Unmet medical need o Long term strategic objectives o Protection of existing franchisees Source: Philips et al

9 MCDA in strategic decision making A portfolio optimization example cont. Benefit criteria Medical Need Business impact Future value Probability of success Extent to which project will meet unmet medical need Protecting the existing business Contribution to evolution to specialty pharmaceutical company Probability that the benefits will be realized Two day decision conference to assess preference values Advance work with Marketing and project teams to measure Withincriterion and acrosscriteria weights judged at decision conference through swing weighing Source: Philips et al MCDA in strategic decision making A portfolio optimization example cont. This is the first time I have seen all our projects on one display. Stimulate teams to re-think strategies Motivation to seek project that will provide better value Source: Philips et al

10 MCDA in strategic decision making A portfolio optimization example cont. This is the first time I have seen all our projects on one display. Stimulate teams to re-think strategies Motivation to seek project that will provide better value Source: Philips et al MCDA in strategic decision making A portfolio optimization example cont. Source: Philips et al Divide complex problem into smaller criteria for assessment Formally incorporate stakeholder preferences into decision analysis Helps increase communication and shared understanding of portfolio Smarter decisions that increase value with available resources 20 10

11 MCDA in strategic decision making Challenges Managing the trade-off between more sophisticated modelling and more attention to the social process Physical or value dependence of one option on the other. Managing uncertainty surrounding NPV, probability of success measurements Managing uncertainty surrounding weights Reaching consensus 21 References Communities and Local Government (CLG). Multi-criteria analysis: A manual Marsh K, Lanitis T, Neasham D, Orfanos P, Caro J. Assessing the Value of Healthcare Interventions Using Multi-Criteria Decision Analysis: A Review of the Literature. Pharmacoeconomics DOI /s Vakaramoko Diaby, Kaitryn Campbell, Ron Goeree - Multi-criteria decision analysis (MCDA) in health care: A bibliometric analysis, Operations Research for Health Care Volume 2, Issues Philips L.D, Bana e Costa C.A.Transparent prioritisation, budgeting and resource allocation with multi-criteria decision analysis and decision conferencing. Ann Oper Res (2007) 154: Rob Baltussen, Louis Niessen, Priority setting of health interventions: the need for multi-criteria decision analysis, Cost effectiveness and resource allocation (2006) 22 11

12 Discussion points 2013 Evidera. All Rights Reserved. Discussion points What are the pros / cons of MCDA as a tool to support business decisions? What are the obstacles to using MCDA to support business decisions? How do we overcome these? Are there any types of decision or contexts where MCDA may be more useful? 24 12