Department of Health Economics, Weber Economía y Salud, c/Norias 123, Majadahonda, 28221, Madrid, Spain.
Department of Dermatology, University Hospital of Puerto Real, Puerto Real, Cádiz, Spain.
BioDrugs. 2018 Jun;32(3):281-291. doi: 10.1007/s40259-018-0284-3.
Multi-criteria decision analysis (MCDA) is a tool that systematically considers multiple factors relevant to health decision-making. The aim of this study was to use an MCDA to assess the value of dupilumab for severe atopic dermatitis compared with secukinumab for moderate to severe plaque psoriasis in Spain.
Following the EVIDEM (Evidence and Value: Impact on DEcision Making) methodology, the estimated value of both interventions was obtained by means of an additive linear model that combined the individual weighting (between 1 and 5) of each criterion with the individual scoring of each intervention in each criterion. Dupilumab was evaluated against placebo, while secukinumab was evaluated against placebo, etanercept and ustekinumab. A retest was performed to assess the reproducibility of weights, scores and value estimates.
The overall MCDA value estimate for dupilumab versus placebo was 0.51 ± 0.14. This value was higher than those obtained for secukinumab: 0.48 ± 0.15 versus placebo, 0.45 ± 0.15 versus etanercept and 0.39 ± 0.18 versus ustekinumab. The highest-value contribution was reported by the patients' group, followed by the clinical professionals and the decision makers. A fundamental element that explained the difference in the scoring between pathologies was the availability of therapeutic alternatives. The retest confirmed the consistency and replicability of the analysis.
Under this methodology, and assuming similar economic costs per patient for both treatments, the results indicated that the overall value estimated of dupilumab for severe atopic dermatitis was similar to, or slightly higher than, that of secukinumab for moderate to severe plaque psoriasis.
多准则决策分析（MCDA）是一种系统地考虑与健康决策相关的多个因素的工具。本研究旨在使用 MCDA 评估度普利尤单抗治疗重度特应性皮炎相对于司库奇尤单抗治疗中重度斑块状银屑病在西班牙的价值。
按照 EVIDEM（证据和价值：对决策的影响）方法，通过加性线性模型获得两种干预措施的估计价值，该模型结合了每个标准的个体权重（1 至 5 之间）和每个标准中每个干预措施的个体评分。评估度普利尤单抗与安慰剂相比，评估司库奇尤单抗与安慰剂、依那西普和乌司奴单抗相比。进行复测以评估权重、评分和价值估计的可重复性。
与安慰剂相比，度普利尤单抗的总体 MCDA 价值估计值为 0.51±0.14。这一数值高于司库奇尤单抗的数值：0.48±0.15 与安慰剂相比，0.45±0.15 与依那西普相比，0.39±0.18 与乌司奴单抗相比。患者群体报告了最高的价值贡献，其次是临床专业人员和决策者。解释两种疾病评分差异的一个基本因素是治疗选择的可用性。复测证实了分析的一致性和可重复性。
在这种方法下，假设两种治疗方法的每位患者经济成本相似，结果表明，重度特应性皮炎患者对度普利尤单抗的总体估计价值与中重度斑块状银屑病患者对司库奇尤单抗的总体估计价值相似或略高。
