A multicriteria decision analysis (MCDA) tool to purchase implantable medical devices in Egypt

Abstract

Background: With the availability of several similar medical devices performing the same function, choosing one for reimbursement is not easy, especially if purchased for a large number of patients. The objective of this project was to create a multicriteria decision analysis (MCDA) tool, that captures and compares all implantable medical devices' attributes, to provide an objective method for choosing among the available options in Egypt.

Method: We conducted a systematic review and expert interviews, to identify the relevant criteria for inclusion in the tool. Subsequently, a workshop was conducted, that involved experts in procuring and tendering medical devices. Experts chose the criteria, ranked them, assigned weights and scoring functions for each criterion, and then created the draft tool. A pilot phase followed; then, another workshop was conducted to fine-tune the tool. We readjusted the tool based on experts' experience with the draft tool.

Results: The final tool included eight criteria, arranged according to their weightage: technical characteristics (29.4%), country of origin (19.5%), use in reference countries (14.9%), supply reliability (11.7%), previous use in tenders (9.0%), instant replacement within product variety (6.9%), pharmacovigilance (4.6%), and refund or replacement (4.0%). Each medical device was assessed on these eight criteria to achieve a final score, that was compared to the alternative devices' scores. Price is not included in the MCDA tool, but it will be added in the financial evaluation phase.

Conclusion: Decisionmakers could use the MCDA tool, to make evidence-based and objective decisions for purchasing implantable devices, in the Egyptian public sector. Post price evaluation, the product with the best value will be chosen for reimbursement.

Highlights: We created an MCDA tool to help decision makers choose between alternative implantable medical devices in Egypt. The MCDA tool includes eight criteria, where price is evaluated as a separate step. "Technical characteristics" and "country of origin" criteria carried the highest weights, thus representing approximately 50% of the decision.

Keywords: Implantable; MCDA; Medical devices; Multicriteria decision analysis; Procurement.

Fig. 1

Project phases The project phases were: (1) Systematic review and expert interviews, (2) First workshop, (3) Pilot phase, (4) Final workshop, and (5) Implementation

Fig. 2

Screening process We screened 278 references identified from Scopus and PubMed, in addition to the first 100 hits from Google Scholar. Six studies were identified through snowball searching. After deduplication, 327 references were screened through titles and abstracts. Of those, 101 were eligible for full text screening. Finally, 46 were included in the data analysis phase

Fig. 3

Criteria domain representation in the studies included in the systematic review. “Cost and economic evaluation” was the most common criterion in the tools identified, followed by technical characteristics, organizational aspects, clinical effectiveness, patients and social aspects, safety, health problem and current use of technology, and legal aspects