Williams P, Mauskopf J, Lebiecki J, Kilburg A. Using multicriteria decision analysis during drug development to predict reimbursement decisions. J Market Access Health Policy. 2014 Oct.

Objective: The objective of the study was to present a process for using multicriteria decision analysis (MCDA) to estimate the probability of a positive recommendation for reimbursement for a new drug given drug and environmental attributes.

Methods: The MCDA process included 1) selection of decisions makers who were representative of those making reimbursement decisions in a specific country; 2) two preworkshop questionnaires to identify the most important attributes and their relative importance for a positive recommendation for a new drug; 3) a 1-day workshop during which participants undertook three tasks: a) they agreed on a final list of decision attributes and their importance weights, b) they developed level descriptions for these attributes and mapped each attribute level to a value function, and c) they developed profiles for hypothetical products “just likely to be reimbursed”; and 4) use of the data from the workshop to develop a prediction algorithm based on a logistic regression analysis. The MCDA process is illustrated using case studies for three countries, the United Kingdom, Germany, and Spain. The extent to which the prediction algorithms for each country captured the decision processes for the workshop participants in our case studies was tested using a postmeeting questionnaire asking the participants to make recommendations for a set of hypothetical products.

Results: The data collected in the case study workshops resulted in a prediction algorithm: 1) for the United Kingdom, the probability of a positive recommendation for different ranges of cost-effectiveness ratios; 2) for Spain, the probability of a positive recommendation at the national and regional levels; and 3) for Germany, the probability of a determination of clinical benefit. The results from the postmeeting questionnaire revealed a high predictive value for the algorithm developed using MCDA.

Conclusions: Prediction algorithms developed using MCDA could be used by pharmaceutical companies when designing their clinical development programs to estimate the likelihood of a favorable reimbursement recommendation for different product profiles and for different positions in the treatment pathway.

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