Objective: Recent years have witnessed an increased interest in the use of multicriteria decision analysis (MCDA) to support health technology assessment (HTA) agencies for setting healthcare priorities. However, its implementation to date has been criticized for being "entirely mechanistic," ignoring opportunity costs, and not following best practice guidelines. This article provides guidance on the use of MCDA in this context. Methods:The present study was based on a systematic review and consensus development. We developed a typology of MCDA studies and good implementation practice. We reviewed 36 studies over the period 1990 to 2018 on their compliance with good practice and developed recommendations. We reached consensus among authors over the course of several review rounds. Results:We identified 3 MCDA study types: qualitative MCDA, quantitative MCDA, and MCDA with decision rules. The types perform differently in terms of quality, consistency, and transparency of recommendations on healthcare priorities. We advise HTA agencies to always include a deliberative component. Agencies should, at a minimum, undertake qualitative MCDA. The use of quantitative MCDA has additional benefits but also poses design challenges. MCDA with decision rules, used by HTA agencies in The Netherlands and the United Kingdom and typically referred to as structured deliberation, has the potential to further improve the formulation of recommendations but has not yet been subjected to broad experimentation and evaluation. Conclusion:MCDA holds large potential to support HTA agencies in setting healthcare priorities, but its implementation needs to be improved.

As budget constraints become more and more visible, there is growing recognition for greater transparency and greater stakeholders' engagement in the pharmaceuticals' pric-ing&reimbursement (P&R) decision making. New frameworks of drugs' value assessments are searched for. Among them, the multi-criteria decision analysis (MCDA) receives more and more attention. In 2014, ISPOR established Task Force to provide methodological recommendations for MCDA utilization in the health care decision making. Still, there is not so much knowledge about the real life experience with MCDA's adaptation to the P&R processes. Areas covered: A systematic literature review was performed to understand the rationale for MCDA adaptation, methodology used as well as its impact on P&R outcomes. Expert commentary: In total 102 hits were found through the search of databases, out of which 18 publications were selected. Although limited in scope, the review highlighted how MCDA can im-prove the decision making processes not only regarding pricing & reimbursement but also contribute to the the risk benefit assessment as well as optimization of treatment outcomes. Still none of re-viewed studies did report how MCDA results actually impacted the real life settings.

BackgroundA Multi Criteria Decision Analysis (MCDA) technique was adopted to reveal the preferences of the Appraisal Body of the Polish HTA agency towards orphan drugs (OMPs).ResultsThere were 34 positive and 23 negative HTA recommendations out of 54 distinctive drug-indication pairs. The MCDA matrix consisted of 13 criteria, seven of which made the most impact on the HTA process. Appraisal of clinical evidence, cost of therapy, and safety considerations were the main contributors to the HTA guidance, whilst advancement of technology and manufacturing costs made the least impact.ConclusionsMCDA can be regarded as a valuable tool for revealing decision makers’ preferences in the healthcare sector. Given that only roughly half of all criteria included in the MCDA matrix were deemed to make an impact on the HTA process, there is certainly some room for improvement with respect to the adaptation of a new approach towards the value assessment of OMPs in Poland.Electronic supplementary materialThe online version of this article (10.1186/s13023-018-0803-9) contains supplementary material, which is available to authorized users.

cohort study, with assessments of clinical outcomes every 6 months. Remission was defined as a mild or lower level on 8 key items of Positive And Negative Symptoms Scale (PANSS)-P1, P2, P3, N1, N4, N6, G5 and G9-for at least 6 months. Symptomatic remission was described at each visit. Bivariate analyses were then conducted to compare groups in terms of symptoms severity, functioning, quality of life and economic burden. A repeated logistic model was finally used to identify risk factors associated with symptomatic remission. Results: The proportion of patients achieving symptomatic remission within 2 years was 36%. This outcome was found to be stable over time: 72% of patients achieving symptomatic remission at any visit remained in remission at the next visit. Significant differences were found between groups in terms of severity (p < 0.0001), functioning (p < 0.0001), quality of life (p < 0.0001) and most of the resource use components (p < 0.0001). Factors associated with remission included baseline depression level (p= 0.005), baseline severity of symptoms (p < 0.0001), baseline functioning (p < 0.0001), and compliance level (p < 0.0001). ConClusions: This research indicates that patients in symptomatic remission have better social functioning, better quality of life and lower resource use than other patients. Achieving symptomatic remission should be an important treatment goal in the treatment of schizophrenia.

When compared to the DD & MHC group, the ASD group was found to be significantly more likely to report issues with availability, obtaining information, and cost of services. CONCLUSIONS: ASD caregivers reported greater difficulty with all five service difficulty measures as compared to caregivers of children with MHC only. However, ASD group reported greater problems only in availability, obtaining information, and cost of services, when compared to DD & MHC group.