Multicriteria decision analysis in health care decision in oncology: a systematic review

ABSTRACT

Introduction

Multicriteria decision analysis (MCDA) has been used to inform health decisions in health technology assessments (HTA) processes. This is particularly important to complex treatment decisions in oncology.

Areas covered

Five databases (PubMed, EMBASE, LILACS, Web of Science and CRD’s NHS Economic Evaluation Database) were searched for studies comparing health technologies in oncology, involving the concept MCDA. The ISPOR MCDA Good Practices Guidelines were used to assess the reporting quality. Study selection, appraisal, and data extraction were performed by two reviewers. Fifteen studies were included. The main decision problem was related to health technology assessment of cancer treatments. Clinicians and public health experts were the most frequent stakeholders. The most frequently included criteria comprised therapeutic benefit, and socio-economic impact. Value measurement approach, direct rating techniques, and additive model for aggregation were used in most studies. Uncertainty analysis revealed the impact of posology and costs on the studies’ results. All studies showed some level of overlapping decision criteria.

Expert opinion

There is considerable diversity of methods in MCDA for healthcare decision-making in oncology. The evidence presented can serve as a resource when considering which stakeholders, criteria, and techniques to include in future MCDA studies in oncology.

KEYWORDS:

• Cancer
• health technology assessment
• MCDA
• multicriteria decision analysis
• Technology Assessment
• biomedical

Article highlights

• In the context of increasing cancer burden, systematic approaches to explicit priority setting are becoming critical to allocate scarce resources.

• MCDA is a holistic approach that has the potential to improve the evaluation of healthcare interventions, capturing social value in a transparent and systematic fashion.

• At the health system level, the main decision problem in oncology is related to HTA of cancer treatments.

• The current review provides a road map to navigate through MCDA methods when conducting studies on decision-making in cancer care.

• A common core of stakeholders to be included in oncology MCDA studies includes: clinicians, public health experts, researchers, patients’ organizations and general public.

• The most frequently included criteria in cancer studies are related to therapeutic benefit or socio-economic impact.

Declaration of interest

P Coelho de Soarez is the recipient of grant from the CNPq (Research Grant No. 302,268/2019-7). E Suzumura holds a doctoral scholarship from the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, National Council of Technological and Scientific Development; Scholarship – Process 381,378/2018-7). Q Hong holds a postdoctoral fellowship from the ‘Fonds de recherche du Québec Santé’ (FRQS). P Coelho de Soarez, A Campolina, and E Suzumura are researchers from the National Institute of Science and Technology for Health Technology Assessment (IATS) — CNPq/Brazil (Research Grant No. 465518/2014-1). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed to the study conception and design. E Suzumura and P Coelho de Soarez contributed to the literature search. E Suzumura, A Campolina, Q Hong, and P Coelho de Soarez contributed to data acquisition and analysis. E Suzumura wrote the first draft of the manuscript and all authors revised it critically for important intellectual content. All authors read and approved the final manuscript.

Additional information

Funding

This paper was not funded.