Comparing patient preferences for medical treatments with ...
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COMPARING PATIENT PREFERENCES FOR MEDICAL TREATMENTS WITH PROMETHEE II:
A PILOT STUDY HENK BROEKHUIZEN, MARJAN HUMMEL, KARIN GROOTHUIS, MAARTEN IJZERMAN
2nd International MCDA workshop on PROMETHEE: Research and Case Studies; Brussels Jan 2015
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Our decision context and requirements
Choice of MCDA method
Pilot study with PROMETHEE II
Methods
Main results
Sensitivity analysis (esp. relevant!)
Discussion
Future work
OVERVIEW
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Decisions before drugs can be used:
Market Access Reimbursement Prescribe
MCDA a structured and transparent method to guide process
Growing interest in health field (Diaby 2013, Marsh 2014, ISPOR
taskforce)
Patient perspective important, can be measured with stated preference
methods This yields probabilistic preference data
How can we transparently integrate these (probabilistic) preferences
in a structured MCDA process?
OUR DECISION CONTEXT AND REQUIREMENTS PROBLEM DEFINITION
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Broekhuizen 2015 review approaches to deal with uncertainty in MCDA
(569 studies identified)
OUR DECISION CONTEXT AND REQUIREMENTS WHAT MCDA METHOD TO USE IN CONJUNCTION WITH PROBABILISTIC DATA?
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Bayesianframework
Deterministicframework
Fuzzy settheory
Grey theory Probabilisticframework
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OUR DECISION CONTEXT AND REQUIREMENTS WHAT MCDA METHOD TO USE IN CONJUNCTION WITH PROBABILISTIC DATA?
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AHP PROMETHEE SMAA
Top 3 MCDA methods used with probabilistic approach
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Goal: choose an antidepressant
Alternatives: Venlafaxine, Bupropion, Duloxetine
Criteria:
1) Response to treatment
2) Achieve remission
3) Minor side effects
4) Major side effects
Weights AHP panel session with 12 patients
But method would readily extend to larger sample sizes
Performance scores derived from clinical trials that compared the drugs
with placebo.
Modeled in Visual PROMETHEE (academic edition) and R
THE PILOT STUDY DESCRIPTION
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THE PILOT STUDY SOURCE DATA
Benefits Risks
Response Remission Adverse events Severe adverse
events
Median weight
(range)
0.62 (0.36 to 0.78) 0.16 (0.07 to 0.34) 0.04 (0.01 to 0.23) 0.19 (0.02 to 0.25)
Odds ratio (95% CI)
Dul vs Plc 1.95 (1.61 to 2.36) 1.91 (1.56 to 2.34) 1.91 (1.50 to 2.43) 0.96 (0.39 to 2.35)
Ven vs Plc 2.04 (1.74 to 2.39) 1.97 (1.64 to 2.36) 1.80 (1.28 to 2.53) ‡‡ 1.27 (0.81 to 2.00)
Bup vs Plc 1.48 (1.20 to 1.82) 1.46 (1.17 to 1.81) 1.55 (1.10 to 2.18) ‡‡ 0.39 (0.16 to 0.95)
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PREFERENCE FUNCTION USED
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MAIN RESULTS GLOBAL FLOWS AT AGGREGATE (GROUP) LEVEL AND FOR 9 PATIENTS
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Response: [22%;100%],
median = 62%, range 36% to 78%
Remission: [0%;100%],
median = 16%, range 7% to 34%
Side effects: [0%;23%],
median = 4%, range 1% to 23%
Severe side effects: [0%;46%],
median = 19%, range 2% to 25%
SENSITIVITY TO VARIATION IN WEIGHTS RANK STABILITY INTERVALS
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Bootstrapping weights, repeat 1000 times
SENSITIVITY TO VARIATION WEIGHTS PROBABILISTIC ANALYSIS
V D
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Sample odds ratios from lognormal distribution 1000 times
SENSITIVITY TO VARIATION WEIGHTS AND SCORES PROBABILISTIC ANALYSIS
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COMPARISON WITH AHP RESULTS
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It is possible to compare the preferences of a large group of patients with
PROMETHEE
Group preferences and individual preferences can be contrasted
Results similar to AHP results
Problem: Visual PROMETHEE limited to 9 scenarios
The meaning of weights?
Can AHP weights really be used for PROMETHEE?
DISCUSSION
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Supporting decision in early stages of health technology
Case: novel imaging modalities for non-small cell lung cancer
Klaske Siegersma (MSc student) will elicit from group of clinical
experts:
Relevant criteria
Criteria weights
Performance scores / preference functions
Piloting weights elicitation for PROMETHEE among patients
Problem: low numerical & health literacy
Incomparability? Veto?
FUTURE WORK
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More information:
http://www.utwente.nl/bms/htsr/Staff/broekhuizen/
Some references:
V. Diaby, K. Campbell, and R. Goeree, “Multi-criteria decision analysis (MCDA) in health care: A bibliometric analysis,”
Oper. Res. Heal. Care, vol. 2, no. 1–2, pp. 20–24, 2013.
K. Marsh, T. Lanitis, D. Neasham, P. Orfanos, and J. Caro, “Assessing the Value of Healthcare Interventions Using
Multi-Criteria Decision Analysis: A Review of the Literature,” Pharmacoeconomics, vol. 32, no. 4, pp. 1–21, 2014.
H. Broekhuizen, C. Groothuis-Oudshoorn, J. van Til, M. Hummel, and M. IJzerman, “A review and classification of
approaches for dealing with uncertainty in multi-criteria decision analysis for healthcare decisions,” Pharmacoeconomics,
p. forthcoming, 2015.
H. Broekhuizen, C. Groothuis-Oudshoorn, A. Hauber, and M. IJzerman, “Integrating patient preferences and clinical trial
data in a quantitative model for benefit-risk assessment.,” in 25th Annual EuroMeeting of the Drug Information
Association, 2012.
THANK YOU!