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Multiple criteria decision analysis for HTA across four EU member states: piloting the Advance Value Framework

Angelis, Aris, Linch, Mark, Montibeller, Gilberto, Molina Lopez, Maria Teresa, Zawada, Anna, Orzel, Kinga, Arickx, Francis, Espin, Jaime and Kanavos, Panos (2019) Multiple criteria decision analysis for HTA across four EU member states: piloting the Advance Value Framework. Social Science and Medicine. ISSN 0037-7856

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Identification Number: 10.1016/j.socscimed.2019.112595


Multiple Criteria Decision Analysis (MCDA) has emerged as a likely methodology for Health Technology Assessment (HTA). However limited empirical evidence is available on its use by decision-makers and only as part of single-setting exercises, without cross-county studies available. This pilot study applies the Advance Value Framework (AVF), an MCDA methodology for HTA based on multi-attribute value theory, through a series of case studies with decision-makers in four countries, to explore its feasibility and compare their value preferences and results. The AVF was applied in the evaluation of three drugs for metastatic, castrate resistant, prostate cancer (abiraterone, cabazitaxel and enzalutamide in the post-chemotherapy indication). Decision conferences were organised in four European countries in collaboration with their HTA or health insurance organisations by engaging relevant assessors and experts: Sweden (TLV), Andalusia/Spain (AETSA), Poland (AOTMiT) and Belgium (INAMI-RIZIV). Participant value preferences, including performance scoring and criteria weighting, were elicited through a facilitated decision-analysis modelling approach using the MACBETH technique. Between 6 and 11 criteria were included in the value model of each country, allocated across four criteria domains; Therapeutic Benefit criteria conistently ranked first across countries in their relative importance. Consistent drug rankings were observed in all settings, with enzalutamide generating the highest overall weighted preference value (WPV) score, followed by abiraterone and cabazitaxel; dividing drugs' overall WPV scores by their costs produced the lowest "cost-per-unit of value" for enzalutamide, followed for abiraterone and cabazitaxel. These results contrast the HTA recommendations and pricing decisions in real life.

Item Type: Article
Official URL:
Additional Information: © 2019 The Author(s)
Divisions: LSE Health
Health Policy
Subjects: R Medicine > RM Therapeutics. Pharmacology
R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Date Deposited: 16 Oct 2019 09:57
Last Modified: 15 Dec 2019 00:51

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