OBJECTIVES: Conventional approaches to assessing the “value” of new therapies have limited scope. There is a need to broaden the view of healthcare “value”, to promote innovation. An ISPOR task force has previously outlined a “Value Flower” of commonly and rarely examined aspects of healthcare value, and concluding that further research is needed. We propose that multi-criteria decision analysis (MCDA), a structured decision-making process which offers flexibility to incorporate multiple criteria into one appraisal, may help enhance HTA decision-making and help broaden the view of what constitutes “value” .

METHODS: A targeted review of the published literature was synthesised on the use of MCDA in HTA decision-making, to understand how MCDA could be further applied to broaden the definition of healthcare value. Following this, a framework was developed on the use of MCDA to assess the novel aspects of value outlined by ISPOR, and facilitate their use in HTA decision-making.

RESULTS: Precedents within HTA decision-making were identified. Key examples of MCDA use within HTA decision-making included: structured decision models for trade-off analyses, development of new decision support tools, and assessment of emerging therapies for rare diseases. Use of MCDA has also been considered by HTA agencies when incorporating stakeholder preferences, weighting multiple endpoints, prioritizing public health interventions for investment, assessing novel technologies, and conducting benefit/risk assessment.

CONCLUSIONS:

MCDA has previously been utilized to explore individual aspects of healthcare value within HTA. We present a recommended framework using the MCDA methodology to improve upon conventional approaches that are used to assess the ”value” of new therapies.