Multiple criteria decision analysis for medicine reimbursement in the Lebanese context

Objective The objective of this exploratory analysis is to reflect and discuss which criteria of multiple criteria decision analysis (MCDA) would be relevant as part of value determination when appraising healthcare interventions in the Lebanese context. Methods A workshop was conducted as part of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Lebanon Chapter and included the two frameworks: Evidence and Value: Impact on Decision Making (EVIDEM) and Advance Value Framework. Thirty-seven participants expressed their individual preferences through a qualitative and a quantitative exercise. Results In the qualitative analysis of both frameworks, participants unanimously agreed on the relevance of comparative efficacy, safety, and impact of medical costs. In EVIDEM, disease severity and unmet needs were also considered to be important criteria by more than 90 percent of the participants. In the quantitative analysis of both frameworks, disease severity ranked first (a mean normalized weight of .1 in EVIDEM and .27 in Advance Value Framework), followed by the size of the population (.09), the type of therapeutic benefit at the patient level (.09) and population level (.08), and the efficacy (.07) in EVIDEM. In the Advance Value Framework, the combined unmet need/disease severity criteria were followed by direct and meaningful end points (.15), safety (.12), contraindications (.08), and indirect surrogate end points (.07). Conclusions The results were concordant with those reported in countries that have conducted similar surveys such as France, Italy, and Spain. The MCDA methodology could be used as a cornerstone to enhance evidence-based discussions among Lebanese stakeholders involved in evaluation and decision-making purposes.