ТЕОРЕТИЧНІ ОСНОВИ І НАПРЯМИ ВИКОРИСТАННЯ МУЛЬТИКРИТЕРІАЛЬНОГО АНАЛІЗУ РІШЕНЬ У ФАРМАЦЕВТИЧНІЙ ГАЛУЗІ УКРАЇНИ ВІДПОВІДНО ДО ЄВРОПЕЙСЬКОГО ВЕКТОРА РЕФОРМУВАННЯ

Abstract

THEORETICAL FOUNDATIONS AND USE OF MULTI-CRITERIA DECISION ANALYSIS IN THE PHARMACEUTICAL SECTOR OF UKRAINE ACCORDING TO THE EUROPEAN REFORMING VECTOR

O.B. Piniazhko, O.M. Zaliska

Danylo Halytsky Lviv National Medical University

The reforming of health care system has been started to carry out in Ukraine. Assessing the value of medical technologies may require new approaches that take into account a more comprehensive  set  of  parameters  than  the incremental cost-effectiveness ratio, ICER/ quality adjusted life years, QALY.

Technological  advancements  in  combination  with  higher  life  expectancy,  higher  patient expectations, and increased prevalence of chronic diseases, have led to significant increases in public spending on pharmaceuticals, which,  on average  account  for 9,3%  of  total health expenditure  or  about  1,4%  of  GDP  across  OECD  countries  (OECD,  2012). Given the resources governments and health systems can spend on healthcare, the pathway to optimal resource allocation passes through cost containment and efficiency improvement policies. 

In  the  context  of  multi-criteria  decision  analysis  (MCDA),  elements  of  value  can  be measured  and  scored  in  their  natural  units  or  through  constructed  scales,  quantitatively  or qualitatively, and weights are assigned to reflect criteria’s importance when combining them. This approach may provide a more comprehensive account  of  value  parameters,  greater  transparency  in  how  multiple  criteria  are  explicitly valued,  weighted,  and  aggregated,  and  a  more  inclusive  approach  to  stakeholder  views  on value.

Our aim was to perform a comparative analysis of the main approaches, methods and stages of MCDA, to determine the urgent and relevant use of MCDA in health care system of Ukraine based on the experience of developed countries.

We have analyzed the ukrainian and foreign publications, articles, systematic reviews, practical guidelines on MCDA in health care using PubMed, EMBASE, Internet resources as search tools.

Decision  analysis  can  provide  an  alternative  way  of  measuring  and  eliciting  value.  In particular, MCDA is both an approach and a set of techniques, with the goal of providing an overall ordering of options by looking at the extent to which a set of objectives are achieved. MCDA methodologies have been suggested for use in public services since 1960.  MCDA has been  used,  on  an experimental basis, in order to assess the benefit-risk (clinical) profile of new medicines for the  purpose  of  regulatory  approval  during  marketing  authorisation  stage  by  the  European  Medicines Agency and others. Its use has also been suggested in health care and value assessment in HTA also offering a conceptual framework.

Although a variety of MCDA methodologies exist, the process of MCDA includes a number of common stages as follows: 1) establishing the decision context by defining the aims of the MDCA, and who the decision makers and other key stakeholders are; 2) identifying the objectives and criteria that reflect the value  associated  with  the  consequences  of  each  option;  3) «scoring»  the  value  associated with the performance of each option against the criteria; 4) «weighting» each of the criteria to reflect their relative importance to the decision; 5) examine the results; 6) conducting a sensitivity analysis of the results to test the influence of changes in scores or weights.

As the results of our review we suggested the urgent and relevant use of MCDA in health care system of Ukraine based on the experience of developed countries. The comparative analysis of the main approaches, methods and stages of MCDA was performed and trends of it’s implementation in the pharmaceutical industry of our country were suggested.

Due to the performed analysis, in our opinion in order to optimize and improve the decision-making process in health care the implementation of MCDA approach will provide transparent and consistent management decisions in Ukraine.