New Advance Value Framework Offered as a Decision-Support Tool for Reimbursement

Researchers at the London School of Economics and Political Science have developed a multiple criteria decision analysis (MCDA) model, The Advance Value Framework, that payers can utilize for evaluating new medicines that come to the market.

The MCDA framework, the authors explained, allows methodological robustness with different phases and stages for implementation in the context of health technology assessment (HTA). The new model, they wrote, is a generic value-based model for HTA assessment that can be a decision-making tool for payers. The generic nature is in that it can be used for any type of health technology: medicines, medical devices, and other interventions in healthcare.

The paper explains that the basic model criteria include:

• Representation of the objectives or key concerns of decision-makers
• Defining attributes at the bottom of the value tree to measure the objectives
• Select decision alternatives

The researchers used a top-down, value-focused approach to incorporate value concerns of decision-makers while being adaptable to diverse decision problems. With respect to attribute definition and the choice of decision alternatives, they had a bottom-up approach for the sake of decision-specific assessment of performance of alternative treatments as needed.

The paper recommends a “value-alternative hybrid thinking” approach, which is, by design, a top-down approach, with decision alternatives being addressed as a bottom-up approach.

Their 5-stage iterative model-building approach used a top-down “value-focused thinking” approach that encompassed 5 steps:

• Systematic literature review
• Expert consultation
• Targeted examination of methods/gray literature
• Consultation with advance-HTA partners
• Wider dissemination and consultation

Of the 2778 abstracts that were screened, a total of 255 articles were selected, and a 101 were finally used. In the European countries where these studies were conducted, the evaluation criteria were focused on:

• Burden of disease
• Therapeutic impact
• Safety profile
• Innovation level
• Socioeconomic impact
• Efficiency

This was only the model building phase, the authors stated in their discussion; model-assessment and model-appraisal phases need to follow. They recommended applying different types of MCDA modeling techniques for the actual value judgements and elicitation of preferences when multiple options are available.

The paper has been published in Social Science & Medicine.