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Razvi Y, Horwitz SL, Cressman C, Wang DE, Shaul RZ, Denburg A. Priority-setting for hospital funding of high-cost innovative drugs and therapeutics: A qualitative institutional case study. PLoS One 2024; 19:e0300519. [PMID: 38498497 PMCID: PMC10947676 DOI: 10.1371/journal.pone.0300519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/28/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES Rising costs of innovative drugs and therapeutics (D&Ts) have led to resource allocation challenges for healthcare institutions. There is limited evidence to guide priority-setting for institutional funding of high-cost D&Ts. This study sought to identify and elaborate on the substantive principles and procedures that should inform institutional funding decisions for high-cost off-formulary D&Ts through a case study of a quaternary care paediatric hospital. METHODS Semi-structured, qualitative interviews, both virtual and in-person, were conducted with institutional stakeholders (i.e. staff clinicians, senior leadership, and pharmacists) (n = 23) and two focus groups at The Hospital for Sick Children in Toronto, Canada. Participants involved in, and impacted by, high-cost off-formulary drug funding decisions were recruited through stratified, purposive sampling. Participants were approached for study involvement between July 27, 2020 and June 7, 2022. Data was analysed through reflexive thematic analysis. RESULTS Institutional resource allocation for high-cost D&Ts was identified as ethically challenging but critical to sustainable access to novel therapies. Important substantive principles included: 1) clinical evidence of safety and efficacy, 2) economic considerations (direct costs, opportunity costs, value for money), 3) ethical principles (social justice, professional/organizational responsibility), and 4) disease-specific considerations. Multidisciplinary deliberation was identified as an essential procedural component of decision-making. Participants identified tension between innovation and the need for evidence-based decision-making; clinician and institutional responsibilities; and value for money and social justice. Participants emphasized the role of health system-level funding allocation in alleviating the financial and moral burden of decision-making by institutions. CONCLUSIONS This study identifies values and processes to aid in the development and implementation of institutional resource allocation frameworks for high-cost innovative D&Ts.
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Affiliation(s)
- Yasmeen Razvi
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- SickKids Research Institute, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Simonne L. Horwitz
- Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Celine Cressman
- SickKids Research Institute, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Daniel E. Wang
- Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Randi Zlotnik Shaul
- SickKids Research Institute, Child Health Evaluative Sciences, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Avram Denburg
- SickKids Research Institute, Child Health Evaluative Sciences, Toronto, ON, Canada
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Wang DE, Hassanein M, Razvi Y, Shaul RZ, Denburg A. Institutional Priority-Setting for Novel Drugs and Therapeutics: A Qualitative Systematic Review. Int J Health Policy Manag 2024; 13:7494. [PMID: 38618836 PMCID: PMC11016276 DOI: 10.34172/ijhpm.2024.7494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/23/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND There is a lack of guidance on approaches to formulary management and funding for high-cost drugs and therapeutics by individual healthcare institutions. The objective of this review was to assess institutional approaches to resource allocation for such therapeutics, with a particular focus on paediatric and rare disease populations. METHODS A search of Embase and MEDLINE was conducted for studies relevant to decision-making for off-formulary, high-cost drugs and therapeutics. Abstracts were evaluated for inclusion based on the Simple Multiple-Attribute Rating Techniques (SMART) criteria. A framework of 30 topics across 4 categories was used to guide data extraction and was based on findings from the initial abstract review and previous health technology assessment (HTA) publications. Reflexive thematic analysis was conducted using QSR NVivo 12 software. RESULTS A total of 168 studies were included for analysis. Only 4 (2%) focused on paediatrics, while 21 (12%) centred on adults and the remainder (85%) did not specify. Thirty-two (19%) studies discussed the importance of high-cost therapeutics and 34 (23%) focused on rare/orphan drugs. Five themes were identified as being relevant to institutional decision-making for high-cost therapeutics: institutional strategy, substantive criteria, procedural considerations, guiding principles and frameworks, and operational activities. Each of these themes encompassed several sub-themes and was complemented by a sixth category specific to paediatrics and rare diseases. CONCLUSION The rising cost of novel drugs and therapeutics underscores the need for robust, evidence-based, and ethically defensible decision-making processes for health technology funding, particularly at the hospital level. Our study highlights practices and themes to aid decision-makers in thinking critically about institutional, substantive, procedural, and operational considerations in support of legitimate decisions about institutional funding of high-cost drugs and therapeutics, as well as opportunities and challenges that exist for paediatric and rare disease populations.
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Affiliation(s)
- Daniel E. Wang
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Maram Hassanein
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yasmeen Razvi
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Randi Zlotnik Shaul
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Avram Denburg
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Division of Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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Németh G, Mágó ML, Kaló Z, Lám J, Balogh T, Brodszky V. A concept for multi-winner tenders for medicinal products with balancing between efficient prices, long-term competition and sustainability of supply. Front Med (Lausanne) 2023; 10:1282698. [PMID: 37964880 PMCID: PMC10642851 DOI: 10.3389/fmed.2023.1282698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Achieving price efficiency via tenders, the sustainability of competition, and the prevention of shortages are hot topics in the debates about shaping the pharmaceutical markets. Single-winner tenders receive growing criticism for concentrating on achieving low prices at the expense of the long-term maintenance of a competitive pharmaceutical industry, the security of continuous supply, and disregarding the therapeutic needs of patient populations with specific conditions. This paper aims at drafting a concept to assist the design of multi-winner tenders for medicinal products with a focus on supply and sales guarantees, price efficiency, and equity in access. The concept shall be generally applicable to all kinds of medicinal products including generics, biosimilars, and on-patent products in the out- and in-patient sector. Principles for multi-winner tenders for medicinal products are set and a number of delimitations are made in order to get rid of factors that prevent clairvoyance amid the various pricing and reimbursement systems when designing a concept. The steps to plan and implement a multi-winner tendering procedure are drafted on the basis of the defined principles. The tender should consist of planning, bidding, preparation, sales, and evaluation phases. Pharmaceutical companies shall make bids with price and quantity pairs, which shall be ranked by prices and if applicable then taking into account other factors. The tenderer shall predefine market shares to the various places of the ranking. A double ceiling shall be applicable for the sales of the winners: their sales must not exceed their quantity offer and the predefined market share applicable to their place in the ranking. The implementation of the concept will require the careful adjustment of the tender conditions to the specificities of the pharmaceutical market concerned on the one hand and to the local pricing and reimbursement system on the other hand.
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Affiliation(s)
- Gergely Németh
- Data-Driven Health Division of National Laboratory for Health Security, Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
- Department of Reimbursement, National Institute of Health Insurance Fund Management, Budapest, Hungary
| | - Mánuel László Mágó
- Institute of Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Judit Lám
- Data-Driven Health Division of National Laboratory for Health Security, Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - Tamás Balogh
- Department of Reimbursement, National Institute of Health Insurance Fund Management, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
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Takami A, Kato M, Deguchi H, Igarashi A. Value elements and methods of value-based pricing for drugs in Japan: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:749-759. [PMID: 37339436 DOI: 10.1080/14737167.2023.2223984] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Value-based pricing (VBP) can be a promising tool for optimizing drug prices. However, there is no consensus on the specific value elements and pricing method that should be used for VBP. AREAS COVERED We performed a systematic review and narrative synthesis to investigate the value elements and pricing method for VBP. The main inclusion criterion was that value elements, VBP method, and estimated prices for actual drugs were reported. We performed a search in MEDLINE and ICHUSHI Web. Eight articles met the selection criteria. Four studies adopted the cost-effectiveness analysis (CEA) approach and the others used different approaches. The CEA approach included the value elements of productivity, value of hope, real option value, disease severity, insurance value in addition to costs and quality-adjusted life years. The other approaches used efficacy, toxicity, novelty, rarity, research and development costs, prognosis, population health burden, unmet needs, and effectiveness. Each study used individual methods to quantify these broader value elements. EXPERT OPINION Both conventional and broader value elements are used for VBP. To allow VBP to be widely applied to various diseases, a simple, versatile method is preferable. Further research is needed to establish VBP method which enables to incorporate broader values.
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Affiliation(s)
- Akina Takami
- Market Access, Public Affairs & Patient Experience, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Masafumi Kato
- Market Access, Public Affairs & Patient Experience, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Hisato Deguchi
- Market Access, Public Affairs & Patient Experience, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
- Department of Public Health, School of Medicine, Yokohama City University, Yokohama, Japan
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Elezbawy B, Fasseeh AN, Sedrak A, Eldessouki R, Gamal M, Eldebeiky M, Amer H, Akeel S, Morsy A, Amin A, Shafik A, Abaza S, Kaló Z. A multi-criteria decision analysis (MCDA) tool for purchasing off-patent oncology medicines in Egypt. J Pharm Policy Pract 2022; 15:10. [PMID: 35232487 PMCID: PMC8886839 DOI: 10.1186/s40545-022-00414-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 02/21/2022] [Indexed: 01/03/2023] Open
Abstract
Background Multi- criteria decision analysis (MCDA) can assist policymakers in objectively choosing between alternative therapeutic options based on multiple value attributes. Our aim was to create an MCDA tool for the national tenders of off-patent oncology medicines in Egypt. Methods An initial list of criteria was developed through a literature review complemented by local expert interviews. Price or cost-related criteria were excluded to abide by the national regulations of the tender process. Next, a workshop hosting diversified stakeholders representing different governmental bodies was held. Anonymous voting was used to rank and weigh the criteria as well as assigning scores. Price was added as a separate step to identify best option based on price per point. The tool was then tested on a national tender sample of off-patent oncology medicines to assess its performance, and it was readjusted accordingly in a second workshop. Results Seven non-price criteria were selected, including use in reference countries (23.49% weight), equivalence with the reference product (18.79%), manufacturing quality (15.53%), provision of pharmacovigilance services (12.94%), supply reliability (10.78%), previous use in local settings (9.8%) and macroeconomic benefit (8.67%). A medicine receives a score ranging from 0 to 100% of each criterion’s weight. The aggregated score is calculated on a hundred-point scale. Based on participants’ consensus, an overall score of 65 was set as a cut-off for passing the technical eligibility phase of the tendering process. Any product receiving a lower score would be disqualified from the tender. For qualified products, the lower price per point represents preferential option for the national tender. Conclusions The created MCDA tool is capable of objectively comparing similar off-patent oncology medicines by considering multiple value attributes and providing reliable scoring functions for each.
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Understanding innovation of health technology assessment methods: the IHTAM framework. Int J Technol Assess Health Care 2022; 38:e16. [DOI: 10.1017/s0266462322000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Adequate methods are urgently needed to guarantee the good practice of health technology assessment (HTA) for technologies with novel properties. The aim of the study was to construct a conceptual framework to help understand the innovation of HTA methods (IHTAM). The construction of the IHTAM framework was based on two scoping reviews, one on the current practice of innovating methods, that is existing HTA frameworks, and one on theoretical foundations for innovating methods outside the HTA discipline. Both aimed to identify and synthesize concepts of innovation (i.e., innovation processes and roles of stakeholders in innovation). Using these concepts, the framework was developed in iterative brainstorming sessions and subsequent discussions with representatives from various stakeholder groups. The framework was constructed based on twenty documents on innovating HTA frameworks and fourteen guidelines from three scientific disciplines. It includes a generic innovation process consisting of three phases (“Identification,” “Development,” and “Implementation”) and nine subphases. In the framework, three roles that HTA stakeholders can play in innovation (“Developers,” “Practitioners,” and “Beneficiaries”) are defined, and a process on how the stakeholders innovate HTA methods is included. The IHTAM framework visualizes systematically which elements and stakeholders are important to the development and implementation of novel HTA methods. The framework could be used by all stakeholders involved in HTA innovation to learn how to engage dynamically and collaborate effectively throughout the innovation process. HTA stakeholders in practice have welcomed the framework, though additional testing of its applicability and acceptance is essential.
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Holtorf AP, Kristin E, Assamawakin A, Upakdee N, Indrianti R, Apinchonbancha N. Case studies for implementing MCDA for tender and purchasing decisions in hospitals in Indonesia and Thailand. J Pharm Policy Pract 2021; 14:52. [PMID: 34127071 PMCID: PMC8200782 DOI: 10.1186/s40545-021-00333-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A multi-criteria decision analysis (MCDA) approach has been suggested for helping purchasers in low- and middle-income countries in an evidence-based assessment of multi-source pharmaceuticals to mitigate potential adverse consequences of price-based decisions on patient access to effective medicines. Six workshops for developing MCDA-instruments for purchasing were conducted in Indonesia, Kazakhstan, Thailand, and Kuwait in 2017-2020. In Indonesia and Thailand, two pilot-initiatives aimed to implement the instruments for hospital drug purchasing decisions. OBJECTIVE By analysing and comparing the experiences and progress from the MCDA-workshops and the two case-examples for hospital implementation in Indonesia and Thailand, we aim to gain insights, which will support future implementation. METHODS The selection of criteria and their average weight were compared quantitatively across the MCDA-instruments developed in all four countries and settings. Implementation experiences from two case-examples were studied, which included (1) testing the instrument across a variety of drugs in seven hospitals in Thailand and (2) implementation in one specialty hospital in Indonesia. Semi-structured interviews were conducted via web-conferences with four diverse stakeholders in the pilot implementation projects in Thailand and Indonesia. The open responses were evaluated through qualitative content analysis and synthesis using grounded theory coding. RESULTS Drivers for implementation were making 'better' decisions, achieving transparency and a rational selection process, reducing drug shortages, and assuring consistent quality. Challenges were seen on the technical level (definition or of criteria, scoring methods, access to data) or change-related challenges (resistance, perception of increased workload, lack of competencies or capabilities, lack of resources). The comparison of the MCDA instruments revealed high similarity, but also clear need for local adaptations in each specific case. CONCLUSION A set a of measures targeting challenges related to utility, methodology, data requirements, capacity building and training as well as the broader societal impact can help to overcome challenges in the implementation. Careful planning of implementation and organizational change is recommended for ensuring commitment and fit to local context and culture. Designing a collaborative change program for each application of MCDA-based purchasing will enable healthcare stakeholders to maximally benefit in terms of quality and effectiveness of care and access for patients.
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Affiliation(s)
- Anke-Peggy Holtorf
- Health Outcomes Strategies GmbH, Colmarerstr 58, 4055 Basel, Switzerland
- College of Pharmacy, Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City, UT USA
| | - Erna Kristin
- Department of Pharmacology Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Anunchai Assamawakin
- Department of Pharmacology, Faculty of Pharmacy, Mahidol University, 447 Sri-ayuthaya Road, Rajathevi, Bangkok, 10400 Thailand
| | - Nilawan Upakdee
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, 65000 Thailand
| | - Rina Indrianti
- PT. Abbott Indonesia, Wisma Pondok Indah 2, Suite 503, Jalan Sultan Iskandar Muda Kav V/ TA., Pondok Indah, Jakarta Selatan, 12310 Indonesia
| | - Napassorn Apinchonbancha
- Abbott Laboratories ltd, No.1, Q House Lumpini, 30th & 33rd Floor, South Sathorn Road, Thungmahamek, Sathorn, Bangkok, 10120 Thailand
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Farghaly MN, Al Dallal SAM, Fasseeh AN, Monsef NA, Suliman EAMA, Tahoun MA, Abaza S, Kaló Z. Recommendation for a Pilot MCDA Tool to Support the Value-Based Purchasing of Generic Medicines in the UAE. Front Pharmacol 2021; 12:680737. [PMID: 34168564 PMCID: PMC8217964 DOI: 10.3389/fphar.2021.680737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/24/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: In recent periods the United Arab Emirates (UAE) has strengthened economic measures in its pharmaceutical policy by promoting local manufacturing and facilitating the use of generic medicines. International examples indicate the importance of quality control elements in the implementation of cost containment policies. Multicriteria Decision Analysis (MCDA) is increasingly used in health care to facilitate health care decision based on multiple objectives. Our objective was to develop a pilot MCDA tool for repeated use to support the value-based purchasing of generic medicines in the UAE. Methods: An international evidence framework was adapted to UAE in a multistakeholder workshop organized by Dubai Health Authority. After validating the relevance of nine criteria in the local jurisdiction, participants decided the ranking and weight of each criterion by anonymous voting. Results: The top four criteria focused on quality elements starting with real-world clinical or economic outcomes (with 19.8% weight), followed by the quality assurance of manufacturing (17.3%), then evidence on the equivalence with the original product (14.8%), and drug formulation and stability (12.3%). The pharmaceutical acquisition cost criteria ranked fifth with 9.4% weight. The bottom four criteria, including reliability of drug supply, macroeconomic benefit, pharmacovigilance and added value services related to the product had similar weights in the range of 5.5–7.7%. Conclusion: Policy-makers in Dubai put high emphasis of value-based health care by incentivizing manufacturers of off-patent pharmaceuticals to generate additional scientific evidence compared to the mandatory minimum and acknowledging efforts to improve quality standards. The MCDA tool is considered suitable to improve the transparency and consistency of decision making in UAE for off-patent pharmaceuticals, and subsequently for other health technologies.
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Affiliation(s)
| | | | - Ahmad Nader Fasseeh
- Doctoral School of Sociology, Eötvös Loránd University, Budapest, Hungary.,Syreon Middle East, Alexandria, Egypt
| | | | | | - Mohamed Attia Tahoun
- Established Pharmaceuticals Division, Abbott Laboratories, Dubai, United Arab Emirates
| | | | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary.,Syreon Research Institute, Budapest, Hungary
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Abdullah AH, Holtorf AP, Al-Hussaini M, Lemay J, Alowayesh M, Kaló Z. Stakeholder driven development of a multi-criteria decision analysis tool for purchasing off-patent pharmaceuticals in Kuwait. J Pharm Policy Pract 2019; 12:9. [PMID: 31011430 PMCID: PMC6466779 DOI: 10.1186/s40545-019-0171-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/22/2019] [Indexed: 12/01/2022] Open
Abstract
Background In Kuwait, the government is planning to improve the specifications for purchase of medicine and to improve the tendering system intending to slow the growth of the expenditure for medicine and to improve the sustainability of the healthcare system. Multiple Criteria Decision Analysis (MCDA) is a method which can help to assess multiple and sometimes conflicting criteria in the evaluation of the available alternatives. The objective of this initiative was to develop collaboratively a MCDA tool which is locally relevant, and which could be used to improve the use of performance indicators in the purchasing of off-patent pharmaceuticals. Methods Nineteen leading experts representing a broad range of pharmaceutical policy stakeholders elaborated a locally adapted MCDA format by following a 7-step process for criteria selection, scoring, ranking and weighting. Results The most important criterion was the price measured as savings versus the originator product with a weight of 35% in the final decision and a full score with a 60% price reduction. In addition, eight criteria were considered important for assessing the product performance in the Kuwaiti healthcare system: ‘equivalence with the reference product’ (weight of 16.2%), ‘stability and drug formulation’ (13.5%), ‘quality assurance’ (11.2%), ‘reliability of drug supply’ (8.8%), ‘macroeconomic benefit’ (5.5%), ‘real world outcomes (clinical and economic)’ (4.2%), ‘pharmacovigilance’ (3.3%), and ‘added value services related to the product’ (2.3%). Conclusions A MCDA model was successfully adapted to the Kuwait decision context by a group of Kuwaiti pharmacists from a broad range of institutions. The participants agreed with the approach and considered it suitable to improve the transparency and consistency of decision making for off-patent pharmaceuticals in Kuwait. A pilot implementation project was proposed.
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Affiliation(s)
| | - Anke-Peggy Holtorf
- Health Outcomes Strategies GmbH, Colmarerstrasse 58, 4055 Basel, CH Switzerland
| | - Maryam Al-Hussaini
- 3Department of Pharmaceutical Sciences, College of Health Sciences, Public Authority for Applied Education and Training PAAET, Kuwait City, Kuwait
| | - Jacinthe Lemay
- 4Department of Pharmacology and Applied Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Maryam Alowayesh
- 5Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.,7Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
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Németh B, Molnár A, Bozóki S, Wijaya K, Inotai A, Campbell JD, Kaló Z. Comparison of weighting methods used in multicriteria decision analysis frameworks in healthcare with focus on low- and middle-income countries. J Comp Eff Res 2019; 8:195-204. [PMID: 30767661 DOI: 10.2217/cer-2018-0102] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Criteria weighting is a key element of multicriteria decision analysis that is becoming extensively used in healthcare decision-making. In our narrative review we describe the advantages and disadvantages of various weighting methods. METHODS An assessment of the eight identified primary criteria weighting methods was compiled on domains including their resource requirements, and potential for bias. RESULTS In general, we found more complex methods to have less potential for bias; however, resource intensity and general participant burden is greater for these methods. CONCLUSION The selection of the most appropriate method depends on the decision-making context. The simple multiattribute rating technique (SMART) method combined with swing-weighting technique and the analytic hierarchy process methods may be the most feasible approaches for low- and middle-income countries.
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Affiliation(s)
| | | | - Sándor Bozóki
- Laboratory on Engineering & Management Intelligence, Research Group of Operations Research & Decision Systems, Institute for Computer Science & Control, Hungarian Academy of Sciences (MTA SZTAKI), Budapest, Hungary.,Department of Operations Research & Actuarial Sciences, Corvinus University of Budapest, Hungary
| | - Kalman Wijaya
- Abbott Established Pharmaceutical Division, Basel, Switzerland
| | - András Inotai
- Syreon Research Institute, Budapest, Hungary.,Department of Health Policy & Health Economics, Eötvös Loránd University (ELTE), Budapest, Hungary
| | - Jonathan D Campbell
- Department of Clinical Pharmacy, University of Colorado, Aurora, CO, 80045, USA
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.,Department of Health Policy & Health Economics, Eötvös Loránd University (ELTE), Budapest, Hungary
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Awaisu A, Niewada M, Greenberg D. Drug Policy Research and Health Technology Assessment in Central and Eastern Europe, Western Asia, and Africa: The Interface Between Research Evidence, Policy, and Practice. Value Health Reg Issues 2018; 16:119-120. [PMID: 30527640 DOI: 10.1016/j.vhri.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Dan Greenberg
- Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Maniadakis N, Holtorf AP, Otávio Corrêa J, Gialama F, Wijaya K. Shaping Pharmaceutical Tenders for Effectiveness and Sustainability in Countries with Expanding Healthcare Coverage. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:591-607. [PMID: 29987759 PMCID: PMC6132432 DOI: 10.1007/s40258-018-0405-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Policy makers in countries, aiming to build and expand their healthcare systems and coverage, need effective procedures to support the most efficient use of limited financial resources. Tendering is commonly deployed to minimize and fix the purchasing price for the contract duration, especially for off-patent pharmaceuticals. While tenders can reduce acquisition costs, they may also expose the healthcare systems to risks including drug shortages, quality trade-offs, and ultimately, compromised patient health outcomes. Careful planning is therefore required. The effectiveness and impact of tendering were examined in different healthcare settings to establish good tender practices and to develop guidance for tender stakeholders in countries with expanding healthcare coverage for the effective conduct. The literature was reviewed for tender practices and outcomes in all countries, and tender experts from one multi-national pharmaceutical company in 17 countries with expanding healthcare coverage were surveyed on current tender practices. Tendering is a common practice for multisource pharmaceuticals in most countries worldwide. However, countries with expanding healthcare coverage specifically are vulnerable to the risks of defective tendering practices. Risk factors include non-transparent tender practices, a lack of consistency, unclear tender award criteria, a focus on lowest price only, single-winner tendering, and generally, a lack of impact monitoring. If well planned, managed, and conducted, tenders can be advantageous. Countries with expanding healthcare coverage should approach tenders strategically to achieve the desired improvements in healthcare. The good tender practices derived from this study may guide policy makers and purchasers in countries with expanding healthcare coverage on how to expand access to healthcare at an affordable cost. These include the use of multiple selection criteria and performance monitoring. Plain Language Summary Decision makers in countries aiming to expand their healthcare systems must best use the limited money available for healthcare. Tendering is commonly deployed for pharmaceuticals produced by multiple manufacturers (so-called multisource pharmaceuticals), to choose the product with the lowest price. Through tenders, purchasers request offers from suppliers for the needed products.The ultimate purpose of our research was to develop a guidance on robust tender processes. Therefore, we reviewed the literature to examine the effectiveness and impact of current tendering practices. In addition, we conducted a survey among tender experts from one pharmaceutical company in 17 countries with expanding healthcare coverage.In both the survey and the literature review, we confirmed that worldwide, tendering is a common practice for multisource pharmaceuticals. However, defective tendering practices may increase the vulnerability for some risks including abuse due to intransparent processes, lack of consistency, unclear tender award criteria, a focus on lowest price only, single winner tendering, and generally, a lack of impact monitoring after the end of the tender process.Hence, tenders must be well planned, managed, and conducted to be advantageous. Countries with defined and transparent tender frameworks and processes will be better equipped to achieve the desired improvements in the healthcare systems. 'Good tender practices' include the clear definition of requirements to be used as selection criteria in addition to acquisition costs, and for monitoring of the tender success. 'Good tender practices' may help to manage cost and improve healthcare at the same time.
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Affiliation(s)
- Nikolaos Maniadakis
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - Anke-Peggy Holtorf
- Health Outcomes Strategies GmbH, Colmarerstrasse 58, 4055 Basel, Switzerland
| | | | - Fotini Gialama
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - Kalman Wijaya
- Abbott Products Operations AG, Allschwil, Switzerland
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Inotai A, Nguyen HT, Hidayat B, Nurgozhin T, Kiet PHT, Campbell JD, Németh B, Maniadakis N, Brixner D, Wijaya K, Kaló Z. Guidance toward the implementation of multicriteria decision analysis framework in developing countries. Expert Rev Pharmacoecon Outcomes Res 2018; 18:585-592. [PMID: 30092151 DOI: 10.1080/14737167.2018.1508345] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Multiple Criteria Decision Analysis (MCDA) is increasingly used in health care mainly because it moves decision-making from ad hoc to an evidence-based and comprehensive process. Developing countries with more restricted financial and human research capacities, however, should consider their own methods of MCDA development and implementation. Areas covered: An MCDA framework to improve procurement decisions of off-patent pharmaceuticals was developed for developing countries and adapted to Indonesia, Kazakhstan and Vietnam during three policy workshops. Based on the experience of these workshops and one joint workshop with international experts and decision makers from multiple developing countries, general recommendations were formulated on how to implement MCDA specifically in developing countries. We provide 17 practical MCDA implementation recommendations in four major areas, including (1) MCDA objectives; (2) technical considerations of MCDA tool; (3) development and customization of MCDA tool and (4) policy implementation of MCDA in decision-making. Expert commentary: These practical MCDA recommendations for developing countries contribute to feasible, transparent, stepwise, iterative and standardized decision-making in health care.
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Affiliation(s)
- András Inotai
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy and Health Economics , Eötvös Loránd University (ELTE) , Budapest , Hungary
| | - Huong Thanh Nguyen
- c Department of Health Policy , Hanoi University of Public Health , Hanoi , Vietnam
| | - Budi Hidayat
- d Center for Health Economics and Policy Studies (CHEPS), Faculty of Public Health , Universitas Indonesia , Depok , Indonesia
| | - Talgat Nurgozhin
- e Asfendiyarov Kazakh National Medical University , Almaty , Kazakhstan
| | - Pham Huy Tuan Kiet
- f Department of Health Economics , Hanoi Medical University , Hanoi , Vietnam
| | - Jonathan D Campbell
- g Department of Clinical Pharmacy , University of Colorado , Aurora , CO , USA
| | | | - Nikos Maniadakis
- h Department of Health Services Organization and Management , National School of Public Health , Athens , Greece
| | - Diana Brixner
- i Department of Pharmacotherapy , University of Utah , Salt Lake City , UT , USA
| | - Kalman Wijaya
- j Abbott Established Pharmaceutical Division, Abbott , Basel , Switzerland
| | - Zoltán Kaló
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy and Health Economics , Eötvös Loránd University (ELTE) , Budapest , Hungary
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