Identifying and Revealing the Importance of Decision-Making Criteria for Health Technology Assessment: A Retrospective Analysis of Reimbursement Recommendations in Ireland

Background: Decisions on reimbursement of health interventions in many jurisdictions are informed by health technology assessments (HTAs). Historically, the focus of these has often been cost effectiveness or cost utility, while other criteria were considered informally. More recently, there has been an increasing interest in the formal incorporation of additional criteria using multi-criteria decision analysis. Such an approach has not yet formally been part of decision-making policy in Ireland. Objective: The objective of this analysis is to demonstrate that cost effectiveness is not the only criterion influencing reimbursement decisions in Ireland. Furthermore, the aim is to reveal criteria that may have informally influenced reimbursement decisions in the past. Methods: A list of potential criteria was identified based on the literature, national guidelines and experience of the national HTA agency. Information on each of these criteria was sought for every assessment conducted in Ireland up to July 2015. A logistic regression was fitted to the data to identify influential parameters. Model selection was performed using the Bolasso method. Results: Thirteen criteria were considered in the analysis. Two members of the HTA review team assessed the performance of the interventions against these criteria. Model selection suggests that the incremental cost-effectiveness ratio and quality of evidence could be important drivers of reimbursement recommendations in Ireland. Less important drivers suggested include the year of assessment, the level of uncertainty, as well as safety and tolerability. Conclusion: The analysis demonstrates that recommendations for or against the reimbursement of technologies in Ireland are not only driven by cost effectiveness. This highlights the need for more formal inclusion of criteria in the process, to improve transparency and ensure consistency.