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Identifying and Revealing the Importance of Decision-Making Criteria for Health Technology Assessment: A Retrospective Analysis of Reimbursement Recommendations in Ireland

Author

Listed:
  • Susanne Schmitz

    (National Centre for Pharmacoeconomics
    Trinity College Dublin)

  • Laura McCullagh

    (National Centre for Pharmacoeconomics
    Trinity College Dublin)

  • Roisin Adams

    (National Centre for Pharmacoeconomics)

  • Michael Barry

    (National Centre for Pharmacoeconomics
    Trinity College Dublin)

  • Cathal Walsh

    (National Centre for Pharmacoeconomics
    University of Limerick)

Abstract

Background Decisions on reimbursement of health interventions in many jurisdictions are informed by health technology assessments (HTAs). Historically, the focus of these has often been cost effectiveness or cost utility, while other criteria were considered informally. More recently, there has been an increasing interest in the formal incorporation of additional criteria using multi-criteria decision analysis. Such an approach has not yet formally been part of decision-making policy in Ireland. Objective The objective of this analysis is to demonstrate that cost effectiveness is not the only criterion influencing reimbursement decisions in Ireland. Furthermore, the aim is to reveal criteria that may have informally influenced reimbursement decisions in the past. Methods A list of potential criteria was identified based on the literature, national guidelines and experience of the national HTA agency. Information on each of these criteria was sought for every assessment conducted in Ireland up to July 2015. A logistic regression was fitted to the data to identify influential parameters. Model selection was performed using the Bolasso method. Results Thirteen criteria were considered in the analysis. Two members of the HTA review team assessed the performance of the interventions against these criteria. Model selection suggests that the incremental cost-effectiveness ratio and quality of evidence could be important drivers of reimbursement recommendations in Ireland. Less important drivers suggested include the year of assessment, the level of uncertainty, as well as safety and tolerability. Conclusion The analysis demonstrates that recommendations for or against the reimbursement of technologies in Ireland are not only driven by cost effectiveness. This highlights the need for more formal inclusion of criteria in the process, to improve transparency and ensure consistency.

Suggested Citation

  • Susanne Schmitz & Laura McCullagh & Roisin Adams & Michael Barry & Cathal Walsh, 2016. "Identifying and Revealing the Importance of Decision-Making Criteria for Health Technology Assessment: A Retrospective Analysis of Reimbursement Recommendations in Ireland," PharmacoEconomics, Springer, vol. 34(9), pages 925-937, September.
  • Handle: RePEc:spr:pharme:v:34:y:2016:i:9:d:10.1007_s40273-016-0406-z
    DOI: 10.1007/s40273-016-0406-z
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    References listed on IDEAS

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    1. P. Thokala & A. Duenas, 2012. "Multiple Criteria Decision Analysis for Health Technology Assessment," Post-Print hal-00800398, HAL.
    2. Nancy Devlin & David Parkin, 2004. "Does NICE have a cost‐effectiveness threshold and what other factors influence its decisions? A binary choice analysis," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 437-452, May.
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    Cited by:

    1. Suaad Almajed & Nora Alotaibi & Sana Zulfiqar & Zahraa Dhuhaibawi & Niall O’Rourke & Richard Gaule & Caoimhe Byrne & Aaron M. Barry & Dylan Keeley & James F. O’Mahony, 2022. "Cost-effectiveness evidence on approved cancer drugs in Ireland: the limits of data availability and implications for public accountability," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(3), pages 375-431, April.
    2. Mónica D. Oliveira & Inês Mataloto & Panos Kanavos, 2019. "Multi-criteria decision analysis for health technology assessment: addressing methodological challenges to improve the state of the art," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(6), pages 891-918, August.
    3. Kanavos, Panos & Visintin, Erica & Gentilini, Arianna, 2023. "Algorithms and heuristics of health technology assessments: A retrospective analysis of factors associated with HTA outcomes for new drugs across seven OECD countries," Social Science & Medicine, Elsevier, vol. 331(C).

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