title: Multi-criteria decision analysis (MCDA): testing a proposed MCDA framework for orphan drugs.
abstract: Since the introduction of the orphan drugs legislation in Europe, it has been suggested that the general method of assessing drugs for reimbursement is not necessarily suitable for orphan drugs. The National Institute for Health and Clinical Excellence indicated that several criteria other than cost and efficacy could be considered in reimbursement decisions for orphan drugs. This study sought to explore the multi-criteria decision analysis (MCDA) framework proposed by (Orphanet J Rare Dis 7:74, 2012) to a range of orphan drugs, with a view to comparing the aggregate scores to the average annual cost per patient for each product, and thus establishing the merit of MCDA as a tool for assessing the value of orphan drugs in relation to their pricings.
  
  
  
  An MCDA framework was developed using the nine criteria proposed by (Orphanet J Rare Dis 7:74, 2012) for the evaluation of orphan drugs, using the suggested numerical scoring system on a scale of 1 to 3 for each criterion. Correlations between the average annual cost of the drugs and aggregate MCDA scores were tested and plotted graphically. Different weightings for each of the attributes were also tested. A further analysis was conducted to test the impact of including the drug cost as an attribute in the aggregate index scores.
  
  
  
  In the drugs studied, the R2, that statistically measures how close the data are to the fitted regression line was 0.79 suggesting a strong correlation between the drug scores and the average annual cost per patient.
  
  
  
  Despite several limitations of the proposed model, this quantitative study provided insight into using MCDA and its relationship to the average annual costs of the products.
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands. carina@gmasoln.com.|Global Market Access Solutions (GMAS), St-Prex, Switzerland. carina@gmasoln.com.
authors.forename: C
authors.initials: C
authors.lastname: Schey
authors.affiliation: Department of Epidemiology, (UMCG), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: P F M
authors.initials: PF
authors.lastname: Krabbe
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|Department of Epidemiology, (UMCG), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Institute for Science in Healthy Aging & healthcaRE (SHARE), UMCg, University of Groningen, Groningen, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Postma
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|Global Market Access Solutions (GMAS), St-Prex, Switzerland.
authors.forename: M P
authors.initials: MP
authors.lastname: Connolly
mesh_terms: D003661:Decision Support Techniques; D055808:Drug Discovery; D006457:Hemoglobinuria, Paroxysmal / Q000188:drug therapy / Q000378:metabolism; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000378:metabolism; D065768:Lennox Gastaut Syndrome / Q000188:drug therapy / Q000378:metabolism; D016532:Mucopolysaccharidosis II / Q000188:drug therapy / Q000378:metabolism; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000378:metabolism; D009965:Orphan Drug Production
keywords: Lennox-Gastaut syndrome; MCDA; Mucopolysaccharidosis II; Multi-criteria decision analysis; Myelodysplastic syndromes; Orphan drugs; Paroxysmal nocturnal haemoglobinuria; Pulmonary arterial hypertension; Reimbursement