A RETROSPECTIVE ANALYSIS OF DRUG REIMBURSEMENT DECISIONS IN IRELAND- A MULTI CRITERIA DECISION ANALYSIS APPROACH

OBJECTIVES: Standard approaches to economic evaluations based on cost utility analysis are increasingly considered inadequate. While simple and intuitive, it is acknowledged that the QALY alone does not capture all aspects of health benefit. Multi Criteria Decision Analysis (MCDA) has been proposed as a way of incorporating multiple factors influencing the value of a health technology. The objective of this study was to analyse past reimbursement recommendations by the National Centre for Pharmacoeconomics (NCPE) in Ireland in order to identify factors which have influenced decisions in the past. METHODS: Based on published literature, national guidelines and experience, a list of potentially influencing criteria was identified. Information on each criterion was extracted for each full pharmacoeconomic assessment conducted by the NCPE. Logistic regression was used to estimate the impact each of these criteria has had on past recommendations. Model fit was assessed using the Deviance Information Criterion and the best fit model was chosen using backwards stepwise regression. RESULTS: Between 2006 and May 2013 the NCPE conducted 54 full pharmacoeconomic assessments. Each of these was scored against 14 criteria, which can be grouped into clinical utility, consumer demand, economic incentives, societal perspective and efficiency/affordability. The model of choice identified criteria of each group which impact on reimbursement recommendations. CONCLUSIONS: This analysis shows that factors other than cost per QALY have impacted on past valuations of health technologies in Ireland. Since the analysis was carried out retrospectively, these factors have influenced decisions in an informal manner and do not necessary represent the factors which should influence future reimbursement decisions. This approach contrasts with methods used elsewhere to estimate weights for the criteria. The results of this analysis provide a basis for the development of a MCDA approach to HTA in Ireland, which has the potential to improve consistent and transparent decision making.