Framework for Drug Formulary Decision Using Multiple-Criteria Decision Analysis

Background. Reviewing drugs to determine coverage or reimbursement level is a complex process that involves significant time and expertise. Review boards gather evidence from the submission provided, input from clinicians and patients, and results of clinical and economic reviews. This information consists of assessments on multiple criteria that often conflict with one another. Multiple-criteria decision analysis (MCDA) includes methods to address complex decision making problems with conflicting objectives and criteria. We propose an MCDA approach that infers a utility model based on reviews of previously submitted drugs. Methods. We use a recent extension of the UTilities Additives DIScriminantes approach, UTADIS(GMS). This disaggregation approach deconstructs a portfolio of elements such as a set of drugs that have been reviewed and for which a decision has been made. It derives global and marginal utility functions that are consistent with the preferences exhibited by the review boards in their recommendations. We apply the method to oncology drugs reviewed in Canada between 2011 and 2017. We also illustrate how to conduct scenario analyses and predict the coverage decisions for new drugs. Results. Applying the method yields a utility value for each submission along with a set of thresholds that partition the utility values based on the submission outcomes. Scenario analyses illustrate the predictive ability of the method. Conclusion. Preference disaggregation is an indirect way of eliciting an additive global utility value function. It requires less of a cognitive effort from the decision making bodies because it infers preferences from the data rather than relying on direct assessments of model parameters. We illustrate how it can be applied to validate existing decisions and to predict the recommendation of a new drug.