Main Article Content

Francois Dionne
Craig Mitton
Bill Dempster
Larry D. Lynd


Coverage decisions, MCDA, drugs, values



Coverage decisions for a new drug revolve around the balance between perceived value and price. But what is the perceived value of a new drug? Traditionally, the assessment of such value has largely revolved around the estimation of cost-effectiveness. How ever, very few will argue that the cost-effectiveness ratio presents a fulsome picture of ‘value’. Multi-criteria decision analysis (MCDA) has been advocated as an alternative to cost-effectiveness analysis and it has been argued that it better reflects real world decision- making.


The objective of this project was to address the issue of the lack of a satisfactory methodology to measure value for drugs by developing a framework to operationalize an MCDA approach incorporating societal values as they pertain to the value of drugs.


Two workshops were held, one in Toronto in conjunction with the CAPT annual conference, and one in Ottawa, as part of the annual CADTH Symposium. Notes were taken at both workshops and the data collected was analyzed using a grounded theory approach. The intent was to reflect, as accurately as possible, what was said at the workshops, without normative judgement.


Results to date are a set of guiding principles and criteria. There are currently ten criteria: Comparative effectiveness, Adoption feasibility, Risks of adverse events, Patient autonomy, Societal benefit, Equity, Strength of evidence, Incidence/prevalence/severity of condition, Innovation, and Disease prevention/ health promotion.


Much progress has been made and it is now time to share the results. Feedback will determine the final shape of the framework proposed.

Abstract 503 | PDF Downloads 213


1. Pharmaceutical Services Division, B.C. Ministry of Health Services. The Drug Review Process in BC. (July 2010) g/drugrevproc2.pdf
2. CADTH. Procedure for Common Drug Review. (January 2013) ocedure_e.pdf
3. Cancer Research UK. What is NICE and how does it work? (August 16, 2013) - help/about -cancer/cancer -questions/what -is- nice -and -how -does -it- work
5. Stafinski T, Browman G, Menon D. Decision - making Processes Regarding Cancer Technologies: A Review. Health Law Review 2008;17:1.
6. Doyle J. The effect of comparative effectiveness research on drug development innovation: a 360° value appraisal. Comparative Effectiveness Research March 2011.
7. National Institute for Health and Care Excellence, Centre for Health Technology Evaluation. Value Based Assessment of Health Technologies. http://www.rees - Guide_for_CONSULTATION_upload_.pdf
8. Drummond M, Towse A. Orphan drugs policies: a suitable case for treatment. The European Journal of Health Economics 2014;4(15):335- 40.
9. Marsh K, Caro J, Muszbek N. Does the future belong to MCDA? ISPOR Connections 2012;18(6).
10. Baltussen R, Niessen L. Priority setting of health interventions: the need for multi-criteria decision analysis. Cost-effectiveness and Resource Allocation 2006; 4:14.
11. Kavanos P, Angelis A. Multiple Criteria Decision Analysis for Value Based Assessment of New Medical technologies: A Conceptual Framework. LSE Health, Working Paper no: 33/2013, March 2013.
12. INESSS. Evaluation process and criteria. (2014) ug- products/evaluation -process -and -criteria.html
13. Danko D. Health technology assessment in middle -income countries: recommendations for a balanced assessment system. Journal of Market Access & Health Policy 2014; 2:23181.
14. Costello Medical Consulting. Review of the ISPOR 16th Annual European Congress 2013. Cambridge, UK, 2013.
15. Mitton C, Donaldson C. Doing healthcare priority setting: principles practice and challenges. Cost-effectiveness and Resource Allocation 2004;2(3).
16. Devlin N, Sussex J. Incorporating multiple criteria in HTA. Office of Health Economics, London, March 2011.
17. Lingard L, Albert M, Levinson W . Grounded theory, mixed methods and action research. BMJ 2008 Aug;7:337.
18. Gibson J, Mitton C, DuBois -Wing G. Priority setting in Ontario’s LHINs: ethics and economics in action. Healthcare Quarterly 2011;14(4):35- 43.
19. Tanios N, Wagner M, Tony M, et al. International Task Force on Decision Criteria. International Journal of Technology Assessment in Healthcare 2013;29(4):456- 65.
20. Cromwell I, Peacock S, Mitton C. Use of priority setting criteria in healthcare. Paper under review 2014.
21. McIntosh E, Donaldson C, Ryan M. Recent advances in the methods of cost-benefit analysis in healthcare. Matching the art to the science. Pharmacoeconomics 1999;15(4):357- 67.
22. Wilson E, Peacock S, Ruta D. Priority setting in practice: what is the best way to combine costs and benefits? Health Economics 2009;18(4):467 -78.
23. Diaby V, Goeree R. How to use multi-criteria decision analysis methods for reimbursement decision -making in healthcare: a step-by-step guide. Expert Review of Pharmacoeconomics & Outcomes Research 10.1586/14737167.2014.859525.