Multiple criteria decision analysis for value based assessment of new medical technologies: a conceptual framework

Assessing the value of new medical technologies may require new approaches that take into account a more comprehensive set of parameters than the incremental cost/QALY. It is argued that MCDA can fulfil this role and has the potential to be methodologically superior to the currently used approaches mainly because of receiving input from multiple, and seemingly relevant criteria or parameters, thus forming a more holistic approach to assessing overall value. Inclusion, scoring and weighting of these parameters would be based on the expertise and opinion of a much wider spectrum of stakeholders involved, thus aiming to achieve an optimal balance across different, and probably opposing, interests. The MCDA score reflecting the overall value of a new medical technology would then be linked to coverage and/or pricing decisions. Coverage decisions could adopt a value for money approach that considers both value and cost of options based on an enhanced costeffectiveness paradigm. Alternatively, for price-setting purposes, a pre-determined link between scores and prices would be needed; however, such a link would be country- and context-specific for each assessment case. Either way, any coverage and/or pricing decision would need to reflect the value as received by the different stakeholders and in relation to a wide range of criteria.