Background and goal of study
Quantifying the benefit/risk profile of medicines is difficult for clinicians, particularly when there are limited published adverse event data, and clinical studies and meta-analyses use different measures of efficacy, safety and tolerability. We tested the ability of an adapted MCDA model to incorporate published data of varying quality and used clinical judgement to assess the benefit/risk profile of postoperative analgesics.

Materials and Methods
Efficacy and safety data from 4 classes of intravenous or intramuscular prescription analgesics indicated for postoperative pain management were used to populate an MCDA model adapted from Moore et al. 2017. Using European Medicines Agency accepted methodology, data were evaluated against the 3 favourable effects (pain relief, duration of action, opioid sparing effect) and the 3 unfavourable effects (cardiac effects, respiratory depression, renal effects) that were judged to potentially impact patient outcomes the most.

Results and Discussion
Applying the MCDA model to 5 postoperative analgesics showed a marked favourable benefit/risk profile for drug B. Figure 1 shows the overall weighted preference scores (maximum=100). Drug B performed well on the favourable effects, particularly pain relief and duration of action, with minimal impact of the unfavourable effects. The model was robust over a range of sensitivity analyses, confirming that results remained relatively unchanged even with significant changes in weights or published evidence. For example, changes of ≥2.5 times the weight were required to make drug A the most preferred option.

Conclusions
The MCDA model presents a useful output that can be adapted to provide clinicians with an easy to interpret benefit/risk analysis to help inform decision making. Data inputs and their clinical interpretation require validation by prescribers who are experts in the field of postoperative pain management. This study was sponsored by Pfizer.

Reference
Moore A, et al. J Pharm Pharmacol. 2017;69:1364–73.

Figure 1. Bar graph of the overall benefit/risk total scores showing how each criterion contributes to the overall benefit/risk.

04 / The feasibility of adapting an over the counter multi-criteria decision analysis (MCDA) model to assess the benefit/risk profile of postoperative analgesics to inform prescribers’ optimal choice of medication