Value Framework Based on Multiple-Criteria Decision Analysis for Assessment of New Health Technologies under Universal Healthcare Coverage System in Taiwan.

Abstract

Objective: Given the lack of a value framework for assessing health technologies in Asian settings, a value framework incorporating multiple-criteria decision analysis (MCDA) for new drugs under universal healthcare coverage in Taiwan was established.

Methods: The development process included: 1) the adoption of five value domains (i.e., "Overall clinical benefit," "Disease burden," "Alignment with patient concerns," "Economic value," and "Feasibility of adoption into the health system") and 26 corresponding indicators, derived from the literature and expert discussions; 2) the creation of separate weighting schemes for three drug types-new oncology, new orphan, and other new drugs-based on inputs from multiple stakeholders (n=86) using various weighting methods; and 3) the application of the value framework to cases of new oncology drugs.

Results: "Overall clinical benefit" had the highest preference weight, irrespective of drug type (i.e., means [95% confidence intervals] for new oncology, new orphan and other new drugs: 32.5 [30.4-34.6], and 30.6 [28.1-33.1], and 30.6 [28.7-32.6], respectively), weighting method, and stakeholder type. The 5 domain-derived weights (from a point allocation method) were comparable with the 26 indicator-derived weights (from the direct rating methods), suggesting that the value framework with a short-form (domain-derived) weighting scheme is sufficient to support decision-makings under time and resource constraints.

Conclusions: A country-specific value framework incorporating MCDA for new drugs was developed in an Asian setting under universal healthcare coverage. It allows multiple stakeholders to systematically appraise all drug value attributes and provides a structured process for adapting and refining value assessments.