Researchers, value assessment experts, and the patient community widely acknowledge that traditional approaches to value assessment often do not account for dimensions of value important to patients and other stakeholders. To explore one method that has been proposed as an alternative or complement to traditional methods, the National Health Council (NHC) and National Pharmaceutical Council (NPC) co-hosted a webinar on Nov. 19 that examined multi-criteria decision-analysis (MCDA). MCDA is a systematic approach to value assessment that can incorporate value elements identified by patients as being important to them, such as caregiver burden and out-of-pocket costs.
The webinar introduced MCDA, discussing comments, suggestions and takeaways from a roundtable on patient-centered MCDA hosted earlier this year, as well as a corresponding NHC/NPC white paper entitled, “Multi-Criteria Decision Analysis: Can It Help Make Value Assessment More Patient Centered?”
Moderated by Dr. Elisabeth Oehrlein, NHC’s Senior Director for Research and Programs, the webinar included experts from industry, academia, value assessment and patient advocacy.
What Is MCDA and Why Is It Important? The University of Colorado School of Pharmacy’s Dr. R. Brett McQueen opened the webinar conversation by defining MCDA and how it differs from traditional cost-effective analysis.
Key Opportunities, Challenges and Considerations for Putting MCDA into Practice
After McQueen defined MCDA and how it can be used in value assessment, NPC Vice President for Health Services Research Kimberly Westrich broke down the challenges and opportunities identified during the roundtable and bucketed them into three key areas:
1) MCDA and Patient Centricity: MCDA provides an opportunity to incorporate the elements of value important to patients and other stakeholders into health care decision making in a transparent and structured manner.
2) Data and Evidence Generation for Patient-Centered MCDA: To obtain meaningful data that reflect patient perspectives and preferences, patients and caregivers should be involved throughout the evidence-generation and selection process.
3) MCDA Implementation and Dissemination: Researchers should pilot test MCDA as an alternative to or in conjunction with cost-effectiveness analysis to learn about incorporating MCDA into decision-making. Development of additional training in MCDA and more user-friendly interfaces also would be beneficial.
Notably, Westrich also highlighted how the process of incorporating MCDA into value assessments must begin before data collection and emphasized the importance of ensuring we measure diverse criteria to achieve holistic value assessments.
The Importance of Pilot Testing and Including Diverse Patient Populations
Jennifer Bright, executive director of the Center for Innovation and Value Initiative (IVI), shared how her organization integrated MCDA into a value assessment for rheumatoid arthritis (RA) patients. Participants were instructed to identify key value inputs important to their personal treatment experiences. IVI found that many patients favored metrics that traditional cost-effective analyses do not capture, such as daily quality-of-life factors, frequency of treatment, and mode of administration.
The Arthritis Foundation’s vice president of advocacy and access, Anna Hyde, said the ultimate goal of patient engagement is to help guide and empower patients directly in their treatment decisions. She also underscored the need for MCDA to include diverse patient populations, even within the same disease area.
MCDA and Rare Disease Value Measurement
McQueen then highlighted how the challenge of value assessment for rare diseases might be able to benefit from the introduction of MCDA.
Oehrlein noted that convenings and educational initiatives like these represent an important step in ensuring all emerging value-assessment approaches and study designs are guided by patient experiences.
When value assessments fail to incorporate the patient voice, they risk falling short of their goal to assess value meaningfully. Actionable next steps for putting MCDA into practice include development of standardized data-collection tools and additional researcher-facing education. In addition, further research efforts and collaboration between patient organizations, researchers and other health care decision-makers will be required to ensure patient centricity in MCDA and carve out a clear path to fully utilizing the approach in practice.