Case studies for implementing MCDA for tender and purchasing decisions in hospitals in Indonesia and Thailand
Tóm tắt
A multi-criteria decision analysis (MCDA) approach has been suggested for helping purchasers in low- and middle-income countries in an evidence-based assessment of multi-source pharmaceuticals to mitigate potential adverse consequences of price-based decisions on patient access to effective medicines. Six workshops for developing MCDA-instruments for purchasing were conducted in Indonesia, Kazakhstan, Thailand, and Kuwait in 2017–2020. In Indonesia and Thailand, two pilot-initiatives aimed to implement the instruments for hospital drug purchasing decisions. By analysing and comparing the experiences and progress from the MCDA-workshops and the two case-examples for hospital implementation in Indonesia and Thailand, we aim to gain insights, which will support future implementation. The selection of criteria and their average weight were compared quantitatively across the MCDA-instruments developed in all four countries and settings. Implementation experiences from two case-examples were studied, which included (1) testing the instrument across a variety of drugs in seven hospitals in Thailand and (2) implementation in one specialty hospital in Indonesia. Semi-structured interviews were conducted via web-conferences with four diverse stakeholders in the pilot implementation projects in Thailand and Indonesia. The open responses were evaluated through qualitative content analysis and synthesis using grounded theory coding. Drivers for implementation were making ‘better’ decisions, achieving transparency and a rational selection process, reducing drug shortages, and assuring consistent quality. Challenges were seen on the technical level (definition or of criteria, scoring methods, access to data) or change-related challenges (resistance, perception of increased workload, lack of competencies or capabilities, lack of resources). The comparison of the MCDA instruments revealed high similarity, but also clear need for local adaptations in each specific case. A set a of measures targeting challenges related to utility, methodology, data requirements, capacity building and training as well as the broader societal impact can help to overcome challenges in the implementation. Careful planning of implementation and organizational change is recommended for ensuring commitment and fit to local context and culture. Designing a collaborative change program for each application of MCDA-based purchasing will enable healthcare stakeholders to maximally benefit in terms of quality and effectiveness of care and access for patients.
Tài liệu tham khảo
Maniadakis N, Kourlaba G, Shen J, Holtorf A. Comprehensive taxonomy and worldwide trends in pharmaceutical policies in relation to country income status. BMC Health Serv Res. 2017;17(1):371.
Johnston A, Holt DW. Substandard drugs: a potential crisis for public health. Br J Clin Pharmacol. 2014;78(2):218–43.
Rinaldi F, de Denus S, Nguyen A, Nattel S, Bussières J-F. Drug shortages: patients and health care providers are all drawing the short straw. Can J Cardiol. 2017;33(2):283–6.
Nakakeeto ON, Elliott BV. Antiretrovirals for low income countries: an analysis of the commercial viability of a highly competitive market. Glob Health. 2013;9(1):6.
Thokala P, Devlin N, Marsh K, Baltussen R, Boysen M, Kalo Z, et al. Multiple criteria decision analysis for health care decision making—an introduction: report 1 of the ISPOR MCDA emerging good practices task force. Value Health. 2016;19(1):1–13.
Brixner D, Maniadakis N, Kaló Z, Hu S, Shen J, Wijaya K. Considering multicriteria decision analysis (MCDA) simple scoring as an evidence-based HTA methodology for evaluating off-patent pharmaceuticals (OPPs) in emerging markets. Value Health Reg Issues. 2017;13:1–6.
Kaló Z, Holtorf A-P, Alfonso-Cristancho R, Shen J, Ágh T, Inotai A, et al. Need for multicriteria evaluation of generic drug policies. Value Health . 2015;18(2):346–51.
Keeney RL, Raiffa H. Decisions with multiple objectives: preferences and value trade-offs. Cambridge: Cambridge University Press; 1993. p. 596.
Inotai A, Brixner D, Maniadakis N, Dwiprahasto I, Kristin E, Prabowo A, et al. Development of multi-criteria analysis (MCDA) framework for off-patent pharmaceuticals—an application on improving tender decision making in Indonesia. BMS Health Serv Res. 2018. https://doi.org/10.1186/s12913-018-3805-3.
Nurgozhin T, Nurtaev A, Maniadakis M. Development of multiple criteria decision analysis framework for off-patent-pharmaceuticals procurement in SK_Pharmacia Kazakhstan. Meditsina Almaty. 2018;2(188):2–13. https://doi.org/10.31082/1728-452X-2018-188-2-22-33.
Abdullah AH, Holtorf A-P, Al-Hussaini M, Lemay J, Alowayesh M, Kaló Z. Stakeholder driven development of a multi-criteria decision analysis tool for purchasing off-patent pharmaceuticals in Kuwait. J Pharm Policy Pract. 2019;12(1):9.
Assawamakin A, Holtorf A-P, Maniadakis N. Weighing price and performance for decisions for multisource pharmaceutical bidding in public hospitals in Thailand. In: Reddy S, editor. Evaluation of Health Programs . London: INTECH Open Access Publisher; 2019. p. 14.
Inotai A, Nguyen HT, Hidayat B, Nurgozhin T, Kiet PHT, Campbell JD, et al. Guidance towards the implementation of multi-criteria decision analysis framework in developing countries. Expert Rev Pharmacoecon Outcomes Res. 2018;18(6):585–92. https://doi.org/10.1080/14737167.2018.1508345.
Kristin E, Bustami M. Workshop on multi-criteria decision analysis (MCDA) in decision-making related to off-patent pharmaceuticals (OPP). Indonesia: University of Gadjah Mada; 2021. (in submission).
Upakdee N, Assamawakin A, Promprasert V, Chungsivapornpong W, Sumitsawan J, Ratanachompoo C, et al. The application price performance for the procurement of government drugs with multiple vendors: case studies in pilot hospitals. Bangkok: The Pharmaceutical Association of Thailand under Royal Patronage; 2020.
Schreier M. Qualitative content analysis in practice. Los Angeles: SAGE; 2012. p. 284.
Neuendorf KA. The content analysis guidebook. Los Angeles: SAGE Publications; 2016. p. 457.
Chapman AL, Hadfield M, Chapman CJ. Qualitative research in healthcare: an introduction to grounded theory using thematic analysis. J R Coll Physicians Edinb. 2015;45(3):201–5.
Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory. 4th ed. Los Angeles: SAGE Publications Inc; 2014. p. 456.
Drake JI, de Hart JCT, Monleón C, Toro W, Valentim J. Utilization of multiple-criteria decision analysis (MCDA) to support healthcare decision-making FIFARMA, 2016. J Mark Access Health Policy. 2017;5(1):1360545.
Poudel A, Nissen LM. Rational and responsible medicines use (Chapter 16). In: Ibrahim MIM, Wertheimer AI, Babar ZUD, editors. Social and administrative aspects of pharmacy in low- and middle-income countries. Cambridge: Academic Press; 2018. p. 263–77 (10.1016/B978-0-12-811228-1.00016-9).
Baltussen R, Marsh K, Thokala P, Diaby V, Castro H, Cleemput I, et al. Multicriteria decision analysis to support health technology assessment agencies: benefits, limitations, and the way forward. Value Health . 2019;22(11):1283–8. https://doi.org/10.1016/j.jval.2019.06.014.
Bakhtiari A, Takian A, Majdzadeh R, Haghdoost AA. Assessment and prioritization of the WHO “best buys” and other recommended interventions for the prevention and control of non-communicable diseases in Iran. BMC Public Health. 2020;20(1):333.
Espinoza MA, Rojas R, de Acosta Patiño H. Knowledge translation in practice: exploring the potential use of MCDA in central America and the Caribbean. Value Health Reg Issues. 2018;17:148–9.
Hu S, Zhang Y, He J, Du L, Xu M, Xie C, et al. A case study of pharmaceutical pricing in china: setting the price for off-patent originators. Appl Health Econ Health Policy. 2015;13(1):13–20. https://doi.org/10.1007/s40258-014-0150-5.
Al-Badriyeh D, Alabbadi I, Fahey M, Al-Khal A, Zaidan M. Multi-indication pharmacotherapeutic multicriteria decision analytic model for the comparative formulary inclusion of proton pump inhibitors in Qatar. Clin Ther. 2016;38(5):1158–73.
Marsh K, Ijzerman M, Thokala P, Baltussen R, Boysen M, Kalo Z, et al. Multiple criteria decision analysis for health care decision making—emerging good practices: report 2 of the ISPOR MCDA emerging good practices task force. Value Health. 2016;19(1):1–13.
Lasalvia P, Prieto-Pinto L, Moreno M, Castrillón J, Romano G, Garzón-Orjuela N, et al. International experiences in multicriteria decision analysis (MCDA) for evaluating orphan drugs: a scoping review. Expert Rev Pharmacoecon Outcomes Res. 2019;19(4):409–20.
Laba T-L, Jiwani B, Crossland R, Mitton C. Can multi-criteria decision analysis (MCDA) be implemented into real-world drug decision-making processes? A Canadian provincial experience. Int J Technol Assess Health Care. 2020;36:434–9. https://doi.org/10.1017/S0266462320000525.
Diaby V, Goeree R, Hoch J, Siebert U. Multi-criteria decision analysis for health technology assessment in Canada: insights from an expert panel discussion. Expert Rev Pharmacoecon Outcomes Res. 2015;15(1):13–9.
Szulanski G. The process of knowledge transfer: a diachronic analysis of stickiness. Organ Behav Hum Decis Process. 2000;82(1):9–27.
Elwyn G, Taubert M, Kowalczuk J. Sticky knowledge: a possible model for investigating implementation in healthcare contexts. Implement Sci. 2007;2(1):44.
Marsh KD, Sculpher M, Caro JJ, Tervonen T. The use of MCDA in HTA: great potential, but more effort needed. Value Health. 2018;21(4):394–7.
Brixner D, Maniadakis N, Kaló Z, Kim K, Wijaya K. An evidence framework for off-patent pharmaceutical review (EFOR) for health technology assessment in emerging markets. Value Health Reg Issues. 2018;16c:9–13.
Kotter JP. Leading Change: Why Transformation Efforts Fail. Harvard Business Review [Internet]. 1995. https://hbr.org/1995/05/leading-change-why-transformation-efforts-fail-2. Accessed 30 Sep 2020.
Kotter JP. Accelerate! Harvard Business Review [Internet]. 2012. https://hbr.org/2012/11/accelerate. Accessed 30 Sep 2020.
Smith N, Hall W, Mitton C, Bryan S, Urquhart B. What constitutes high performance in priority setting and resource allocation? Decision maker narratives identified from a survey and qualitative study in Canadian healthcare organizations. Health Serv Manage Res. 2014. https://doi.org/10.1177/0951484814559714.