Multicriteria decision making (MCDA) in health care - against Pavel Vorobiev Russian Society for Pharmacoeconomics and Outcomes Research ISPOR EUROPEAN CONGRESS, November, 2014 Economy - a scientific prediction of the future: Multicriteria analysis - one of the methods in Foresight methodology Foresight - a systematic evaluation methodology of the future of science, technology, economy and society with a view to identifying areas of strategic research and deployment of technologies, bringing the biggest economic and social benefits 1
Backcasting Bibliometical analysis Brainstorming Citizens Panels Cross-Impact Analysis Delphi Environmental Scanning Essays Expert Panels Futures Workshops Gaming Key Technologies Literature Review Megatrend Analysis Modelling and simulation Multi-criteria Analysis Scenarios Stakeholder Mapping SWOT Analysis Technology Roadmapping Trend Extrapolation Foresight technologies Обратное сценирование Библиографический анализ Мозговые штурмы Общественные панели Анализ взаимных воздействий Метод дельфи Сканирование источников Испытания Экспертные панели Разработка будущего Игры Выделение ключевых технологий Обзор источников Анализ глобальных трендов Моделирование и симуляции Мультикритериальный анализ Сценирование Картирование стейкхолдеров СВОТ-анализ Картирование технологий Экстраполяция трендов http://foresight.sfu-kras.ru/node/49 Multi-Criteria Analysis MCA Structuring the process of selection and evaluation of alternatives based on a combination of quantitative and qualitative criteria to evaluate and compare technologies in order to achieve mutual understanding and elimination of contradictions between the various stakeholders, involved in the decision-making process 4 Consensus in the process of consultation 2
Pharmacoeconomics and clinical and economic analysis Appeared at the end of the 80s. of XX century as a methodology that complements exclusively clinical and social studies in decisions about the payment of technologies in the health system There are analyzes that take into account different points of view: the consumer, the provider of medical services and medicines manufacturer and payer The approach of "economic effectiveness" allows to compare the incomparable: generic products with innovative, different medical technologies (drugs and non-drugs) used in one disease, the technology for various diseases, the effectiveness of health systems in different countries However... There are diseases for which a purely economic approach is not applicable for example, medical technologies used for rare diseases Taking into account only the coefficient «ICER» in the evaluation of these of technologies leads to a refusal to reimbursement, and in refusing in the treatment of patients It is believed that the inclusion of the different criteria in decision making is the closest to real life, and structuring technology of decision making allows you to make this approach scientific 3
Multicriteria decision analysis - prerequisites for medicine Key assumptions (hypotheses) - A lot of subjective assessments lead to one objective?! -Traditional clinical and economic approaches are insufficiently adequate for health technology assessment -The main in decision-making in health care is equity and equality for all patients MCDA MODELS Value measurement model: each of the criteria is defined in the numerical expression compares the sum of criteria for each technology Out ranking model: comparison of alternatives with each other for each criterion amount of superiority by rating Goal, aspiration, or reference-level model: for each of the criteria is determined the level below which model does not work, then there is comparison of the results of the application of each technology, calculated amount of remaining values Thokala P., Duenas A. Multiple Criteria Decision Analysis for Health Technology Assessment. Value in Health 15(2012), 1172 1181 4
Alternative to MCDA RULE OF SQUARE OF DECISION- MAKING (P.VOROBIEV, 2003) Informational space S C I E N C E Verge of analysis and modeling Information field - the relevant information Information verge Decision-makers Verge of subject-object relationships Verge of nonspecific action S O C I E T Y Object on which impacts made decision Verge of analysis and modeling Constructed and justified different models that relate to for example place of this drug in the treatment of this disease Mathematical device is involved and the results of studies carried out in accordance with the rules of medicine based on evidence 5
Verge of subject-object relationships The resistance of the object on which the decision was addressed, affects the final decision Subject-object relations always have the character of the conflict It can be solved directly, as well as entering into resonance, or by consensus (but then it would not be enforceable if it remains disagreement - then a decision only exacerbates resistance) Verge of nonspecific action Nonspecific effects can be very significant An example might be a long time between the decision and the onset of action Changes in the political arena, new managers, professionals The discussion about these factors is especially important 6
Stages of MCDA 1. Identification of the decision situation. 2. Choice of the purpose of this decision. 3. Determination of criteria on the basis of detailed objectives, as well as the minimum level that will satisfy the decision maker. 4. Assigning weights to each criterion, depending on the preferences of the decision maker. 5. Getting information about the parameters for decision-making and the development of alternatives. 6. Evaluation of different options in accordance with established criteria. 7. Summing the products of different weights of criteria and sub-evaluations of individual options and assess the usefulness of different options. Option that receives the maximum number of points is the most rational option. 8. To confirm your choice, you can navigate through the various results of simulations. 13 MCDA a skeptical point of view 1. Who determines the criteria and who appreciates their weight? 2. How to compare different medical technologies with each other? 3. Should only the principles of justice and equality stand at the forefront of decision-making? 4. What to do if there is unavoidable contradictions? 7
Who determines the criteria and who appreciates their weight? This is the most controversial issue Selection of experts arbitrary, not difficult to find the needed experts Experts are under influence to other factors: personal experience, ethical preferences, the media, the environment (rule of a square of decision-making) how to take into account? Are the criteria selected in a proper way Are the weights given to grade criteria selected properly How in MCDA the verges of square of decision making are taken into account? Verge of nonspecific action Analysys and modelling There is an impression that MCDA solves only a problem of verge of subject-object relationships 8
KEEP IT SIMPLE the simpler analysis is, the easier it is to reconduct - aren t we leaving this priciple? MCDA should be - the maximum - built into system of decision-making, as the jury - in court: their business to say whether the one is guilty or not, and experts on multicriteria analysis: are the technologies acceptable or not? Multicriteria analysis should be considered in the evaluation of medical technology, but can not be decisive 9
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