OBJECTIVES: This study aims to develop a value assessment tool for the decision-making of systemic antifungals listing into drug formulary of China’s hospitals, and to perform a preliminary evaluation on three newly-launched antifungals: Liposomal amphotericin B (L-AmB), Isavuconazonium Sulfate for Injection (ISA) and Amphotericin B Colloidal Dispersion (ABCD).

METHODS: A multi-criteria decision analysis approach was applied. Value criteria were identified and structured based on the generic framework from Drug Selection Guideline for Medical Institutions, and further crafted with expert consultation to reflect special considerations in antifungals. Measuring Attractiveness by a Categorical Based Evaluation Technique (MACBETH) method and Analytic Hierarchy Process method were used for scoring and weighting respectively. Value preferences of key stakeholders were elicited through pairwise comparison via online questionnaire. Performance of alternatives was extracted from publicly available information. Given the number limit for systemic antifungals in hospital formulary required by China’s antimicrobial stewardship, an assumption was made that five most commonly-used antifungals (voriconazole, caspofungin etc.) were in the formulary. Subgroup analyses were performed to understand stakeholder heterogeneity. One-way sensitivity and scenario analyses were also conducted.

RESULTS: 30 criteria of 10 value attributes were finally included. With preferences gathered from 22 physicians or pharmacists nationwide, a partial value function for each criterion was constructed for scoring. The weights for clinical necessity (20.0%) and efficacy (19.1%) were the highest. Preliminary results showed that the total scores of ISA (71) and L-AmB (71) were higher than ABCD (61). Total scores were most influenced by the weight of “Unique advantage”. ISA and L-AmB were consistently top-ranked with different orders in scenario and subgroup analyses, supporting the overall robustness of evaluation.

CONCLUSIONS: A re-usable value assessment framework is established for systemic antifungal drug listing decision in Chinese hospitals. This tool provides systematic assessment with multiple value criteria synthesized, tailored to the needs of decision-making of hospital authority.