Abstract
Background: The application of multi-criteria decision analysis in healthcare, has recently increased as decision makers seek robust data to inform policy decisions. The present study aimed at evaluating the benefits of three licensed drug (Ranibizumab, Dexamethasone and Aflibercept), for treating diabetic macular edema, within 4 Italian regional settings, according to a multi-criteria decision analysis based on the Core Model domains. Methods: After the assessment of the EUnetHTA Core Model domains, an appraisal was then undertaken by applying the multi-criteria decision analysis methodology, according to 11 criteria. An initial domain-prioritization phase was followed by the technology evaluation across domains. The four appraisals were compared to identify how closely they matched. Results: Despite the differing professional roles of the experts from four separate Regional healthcare systems, the only statistically significant differences found in the domain-prioritization phase, was the heterogeneity of weight given to the equity dimension (p=0.013). Similarly, the scores attributed to each domain for a particular technology showed minimal inter-evaluator variability, demonstrating the robustness of this multi-criteria decision analysis. The only significant difference found, was that Dexamethasone received higher scores in the safety and efficacy dimensions (p=0.002). The appraisals in all 4 regions demonstrated that Dexamethasone implant received a higher overall score than the comparator technologies. Conclusions: The evaluation demonstrates that multi-criteria decision analysis can enhance the technology assessment process, providing decision makers with a robust method of assessing the preferable treatment options, for patients suffering from diabetic macular edema.