OBJECTIVES: To identify criteria for prioritizing osteoporosis treatments in postmenopausal women at very high fracture risk, based on the preferences of three groups of stakeholders: medical specialists, representatives of patient associations and healthcare managers (HM).

METHODS: A literature review identified criteria for technology prioritization for the patient population of interest and was validated among participants. Three representatives from each group indicated preferences and weights among the validated criteria using the Analytic Hierarchy Process methodology in a MCDA panel.

RESULTS: The key categories identified in the panel were efficacy (clinical, new vertebral, non-vertebral and hip fracture, and bone mineral density), safety (clinically significant adverse events and tolerability), convenience (adherence and dosing convenience) and economics (incremental cost-effectiveness ratio, cost per responder, budget impact and socioeconomic impact). New hip fracture and clinical fractures appeared in the top five criteria for all groups. All fracture types, especially new hip fracture (weight 26.11%), and adverse events (14.64%) were the main criteria for medical specialists. Similar results were observed for patient associations, with any factures weighted most highly (25.09% to 10.61%) whilst economic criteria received the lowest weights (1.21% to 0.98%), below dosing convenience (4.29%). Economic category was prioritized only for the HM group (48.46%).

CONCLUSIONS: Although weights varied across each group of stakeholders, reflecting different preferences and perspectives, treatment efficacy was prioritized for all. It is noteworthy that economic criteria have a high impact on decision making from the HM perspective but other criteria, such as dosing convenience, could have higher weight in health technologies assessment process, including patient preferences. These results have the potential to assist decision making and treatment prioritization for women with postmenopausal osteoporosis at very high risk of fracture.