Comparative clinical evaluation of endothelin receptor antagonists in pulmonary arterial hypertension using a multi-criteria decision analysis framework
Abstract
Introduction: Endothelin receptor antagonists are important therapies for pulmonary arterial hypertension, but differences in efficacy, safety, monitoring requirements, drug interactions, costs, and accessibility complicate treatment selection.
Aim: To compare endothelin receptor antagonists across safety, efficacy, economic value, suitability, accessibility, and innovation, and to develop a multidimensional framework for clinical pharmacy decision-making and formulary management.
Method: A structured framework was developed through a two-round Delphi process involving 19 multidisciplinary experts. Indicators were classified as quantitative or qualitative and organized into six domains. Consensus was assessed using the authority coefficient, coefficient of variation, and Kendall's coefficient of concordance. Weights were determined using the analytic hierarchy process and integrated through multi-criteria decision analysis. Quantitative evidence was derived from regulatory sources, randomized trial meta-analysis, national pricing databases, and hospital procurement records. Qualitative indicators, including monitoring requirements, drug interactions, adherence-related factors, accessibility, and innovation, were scored using predefined criteria. Economic value was evaluated in the Chinese healthcare context using annual drug acquisition costs, affordability ratios, and cost per metre improvement in 6-min walk distance.
Results: The Delphi process established a framework…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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