Validation, adaptation and application of a multi-criteria decision analysis-based framework for chemotherapeutic agents in Egypt

Health technology assessment is a systematic, transparent, robust, and unbiased assessment of healthcare technology that links evidence and decisions. Healthcare decisions usually require trading-off, and using a structured approach, such as multi-criteria decision analysis (MCDA), could improve decision quality. This study aimed to adapt an MCDA-based framework for oncological drug evaluation in an Egyptian clinical setting to explore the perspectives of different stakeholders. The 10th edition of the Evidence and Value: Impact on decision making framework was translated, validated, adapted, and applied to explore key differences between the priorities of different stakeholders for coverage decisions in the oncology field in Egypt. A direct rating scale or hierarchical point allocation was used to elicit criteria weights. Normalized weights were calculated and compared using the preset cut-off value of 0.008. Understandability, willingness to use the adopted weighting techniques, and cognitive burden were assessed and compared. Ninety participants completed the criteria-weighting interview for the adapted tool. The elicited criteria weights differed between the two adopted weighting techniques when comparing stakeholders' priorities using the preset cut-off (0.008). However, there was no significant difference in the weighting technique understandability, future use willingness, and cognitive burden parameters on categorization by either the weighting technique or stakeholder group. This study provides a specially tailored, straightforward procedure for Egyptian stakeholders to evaluate oncologic drugs in a standardized manner by combining various inputs. It also highlights the main variations across Egyptian stakeholder preferences.