Description
Background: Pharmacy and therapeutics (P&T) committees must evaluate competing medications within the constraints of finite healthcare resources. Traditional formulary decision-making processes may inadequately capture the multidimensional value of medications. Multi-criteria decision analysis (MCDA) has emerged as a structured approach to incorporate clinical, economic, and operational considerations; however, evidence of its real-world application in P&T committee decision-making remains limited. Objectives: (1) To systematically review and synthesize published literature describing the use of MCDA in formulary decision-making by P&T committees. (2) To develop a conceptual MCDA framework and demonstrate its feasibility through a proof-of-concept application within a P&T committee context. Methods: A systematic literature review was conducted following PRISMA guidelines. Electronic databases were searched for studies published between 2010 and 2025 that applied MCDA to support P&T committee formulary decisions. Studies were screened using predefined inclusion and exclusion criteria. Data were extracted and synthesized descriptively, focusing on MCDA frameworks, decision criteria, weighting and scoring methods, stakeholder involvement, and decision outcomes. In parallel, a proof-of-concept MCDA framework was developed to demonstrate its practical application in a simulated P&T committee formulary decision-making context. Results: Of 443 records identified, 96 articles were reviewed in full text, and eight studies met the inclusion criteria. P&T committees used MCDA frameworks to balance clinical criteria (e.g., efficacy, safety) with pharmacoeconomic considerations (e.g., cost, cost-effectiveness). Additional criteria included manufacturing quality, drug supply reliability, and equivalence to reference products. The linear additive model was the most frequently employed MCDA framework. Rating scales were commonly used for scoring, while the analytic hierarchy process was the predominant approach used to derive weights for decision criteria. Reporting quality varied, with several studies lacking full documentation or justification of MCDA methodological choices. The proof-of-concept application demonstrated the feasibility of integrating MCDA into P&T committee deliberations by enabling structured comparison of formulary alternatives across multiple weighted criteria. Conclusions: Despite limited published evidence, MCDA shows promise as a transparent and systematic tool for formulary decision-making. Its use may enhance stakeholder engagement and support
Publication Info
2026.