Evaluating the benefits of new drugs in health technology assessment using multiple criteria decision analysis: a case study on metastatic prostate cancer with the dental and pharmaceuticals benefits agency (TLV) in Sweden

Background: Multiple Criteria Decision Analysis (MCDA) has been identified as a prospective methodology for assisting decision-makers in evaluating the benefits of new medicines in Health Technology Assessment (HTA), however limited empirical evidence exists from real-world applications. Objective: To test in practice a recently developed MCDA methodological framework for HTA, the Advance Value Framework, in a proof-of-concept case study with decision-makers. Methods: A multi-attribute value theory methodology was adopted applying the MACBETH questioning protocol through a facilitated decision-analysis modelling approach as part of a decision conference with four experts. Settings: The remit of the Swedish Dental and Pharmaceutical Benefits Agency (Tandvårds- och läkemedelsförmånsverket, TLV) was adopted but in addition supplementary value dimensions were considered. Patients: Metastatic castrate resistant prostate cancer patients having received prior chemotherapy. Interventions: Abiraterone, cabazitaxel and enzalutamide as third-line treatments. Measurements: Elicitation of participants value preferences involving criteria selection, options scoring, criteria weighting and their aggregation. Results: Eight criteria attributes were finally included in the model relating to therapeutic impact, safety profile, socioeconomic impact and innovation level with relative importance weights of 44.5%, 33.3%, 14.8% and 7.4% per cluster respectively. Enzalutamide scored the highest overall weighted preference value (WPV) score, followed by abiraterone and cabazitaxel. Dividing treatments’ overall WPV scores by their costs derived “costs per unit of value” for ranking the treatments based on value-for-money grounds. Limitations: Lack of comparative clinical effects across treatments and small sample of participants. Conclusion: The Advance Value Framework has the prospects of facilitating the evaluation process in HTA and health care decision-making, however additional research is needed to address technical challenges and optimise its use in policy-making.