Multi-Criteria Decision Analysis to Develop an Efficacy-Safety Profile of Parenteral Analgesics Used in the Treatment of Postoperative Pain

Figures & data

Figure 1 Effects tree for determining the comparative efficacy-safety balance of the analgesics and placebo.

Abbreviations: AEs, adverse events; GI, gastrointestinal; SAEs; serious adverse events.

Table 1 Final Weights of the Criteria Comprising the MCDA Model

Criterion Type	Criterion	Individual Criterion Weight (%)	Cumulative Weight (%)
Efficacy	Pain relief	28.9	28.9
Efficacy	Opioid sparing	23.1	52.0
Efficacy	Duration of action	11.6	63.6
SAE	GI effects	11.6	75.1
SAE	Respiratory depression	9.2	84.4
SAE	Cardiac effects	4.6	89.0
SAE	Renal impairment	4.6	93.6
SAE	Agranulocytosis	1.2	94.8
SAE	Liver dysfunction	1.2	96.0
AE	Nausea/vomiting	1.2	97.1
SAE	Anaphylaxis	0.6	97.7
Safety	Overdose toxicity	0.6	98.3
AE	Itchiness	0.6	98.8
AE	Hypotension	0.6	99.4
AE	Psychomimetic effects	0.6	100.0
AE	Increased creatinine	0.0	100.0
AE	Hepatic effects	0.0	100.0

Abbreviations: AE, adverse event; GI, gastrointestinal; MCDA, multi-criteria decision analysis; SAE, serious adverse event.

Figure 2 Adjusted preference scores of analgesics, broken down by individual efficacy and safety criteria (Primary analysis). More favorable efficacy is represented by a greater column height. More favorable safety is represented by a greater column height. The numerical values of individual efficacy and safety criteria are listed by compound in Supplementary Table 1.

Abbreviations: ACET, acetaminophen; DIC, diclofenac; GI, gastrointestinal; KET, ketorolac; MET, metamizole; MORPH, morphine; NEF, nefopam; PAR, parecoxib; PBO, placebo; Resp, respiratory; TRAM, tramadol.

Figure 3 Comparison of parecoxib versus morphine based on weighted score differences for each criterion.

Notes: Effects are shown in order of weighted difference, with sum equal to the difference in overall preference values. Positive values (green bars) indicate advantage of parecoxib and negative values (red bars) indicate advantage of morphine.

Abbreviations: AE, adverse event; Cum Wt, cumulative weight; Diff, difference; Wtd Diff, weighted difference; SAE, serious adverse event.

Figure 4 Adjusted preference scores of analgesics, broken down by individual efficacy and safety criteria (Sensitivity analysis: Opioid-sparing effect weight = 0). More favorable efficacy is represented by a greater column height. More favorable safety is represented by a greater column height. The numerical values of individual efficacy and safety criteria are listed by compound in Supplementary Table 1.

Abbreviations: ACET, acetaminophen; DIC, diclofenac; GI, gastrointestinal; KET, ketorolac; MET, metamizole; MORPH, morphine; NEF, nefopam; PAR, parecoxib; PBO, placebo; Resp, respiratory; TRAM, tramadol.

Figure 5 Preference scores of analgesics based on separately weighted efficacy and safety criteria.

Abbreviations: EFF, total efficacy score; SAF, total safety score.