Applying Continual Stakeholder Engagement to Develop Multi-Criteria Decision Analysis (MCDA) for Health Technology Assessment in Major Depressive Disorder (MDD)

OBJECTIVES: Engagement with decision-makers is crucial to the development of decision tools in health technology assessment. This study applied a continual stakeholder engagement approach to develop an open-source multi-criteria decision analysis (MCDA) to support decision-making in major depressive disorder (MDD) by diverse stakeholders in the US.

METHODS: The MCDA was developed based on the 8-step process in ISPOR Good Practices Reports. We convened a twenty-member advisory group (AG) consisting of representatives from patient, clinician, employer, payer, manufacturer, and researcher perspectives throughout the process to ensure the module can effectively address real-world decision needs. Facilitated discussions were conducted to define decision problems, prioritize criteria, and identify performance metrics for different criteria. Three MCDA experts provided guidance to identify the best approaches to incorporate stakeholder insights into MCDA and most appropriate methods for eliciting weights and scores. The design was also informed by a cost-effectiveness model (e.g., outputs as performance metrics for the criteria) and a patient preference study that estimated how patients make trade-offs in MDD treatment selection (e.g., preference weights as criteria weights).

RESULTS: The MCDA is designed to support population-level decision-making by multi-stakeholder committees to evaluate the value of individual treatments and treatment sequences for MDD. A total of 21 criteria across 4 domains (clinical benefits, productivity, caregiver impacts, and equity impacts) that represented potential decision factors for diverse stakeholders were included. The initial weights will be derived based on multi-stakeholder committees and will be user-modifiable. A linear partial value function is used to convert performance measures into scores for each criterion. Aggregate scores are calculated as the weighted sum of criterion-specific scores and determine ranking of different alternatives.

CONCLUSIONS: Continual stakeholder engagement has generated important insights that have informed the design of the MCDA, which will yield a flexible open-source tool that can better support healthcare decision-making by various stakeholders.