**2. Methods**

On June 29, 2018, key stakeholders and experts in pharmaceutical bidding policies in Thailand came together on invitation by the Pharmaceutical Association of Thailand under Royal Patronage (PAT). The 37 active workshop participants represented multiple perspectives in Thailand (24 pharmaceutical purchasing (12 of these from leading hospitals), 7 academic pharmacy education leaders, 4 from the Ministry of Health, 1 from PAT, and 1 from an industry association) in addition to 2 observers from the regulatory perspective. During the 1-day workshop, all active participants were involved in developing an MCDA tool which can be used in making decisions in the hospital bidding setting.

Two international health policy advisors moderated the workshop following a validated MCDA calculation model and process for local adaptation [13]. Together with the local leader of the initiative, the international experts used a structured process as described in **Figure 1** to prepare the workshop, align the participants' expectations and knowledge at the workshop, and to guide the workshop participants through five steps for the local adaptation of the MCDA format. The international advisors conducted the workshop in English language. However, to ensure that all participants could follow the discussions and freely express their experiences and opinions at all times, independent of their knowledge of either Thai or English, the workshop was supported by a two-way simultaneous translation.

The workshop started by defining all non-price criteria which may be relevant in the Thai decision process. These were defined starting from the


#### **Figure 1.**

*Description of the entire process for developing a value-based decision tool for multisource pharmaceutical bidding in Thai hospitals.*

basic decision criteria proposed by international health policy thought leaders [2] and an adapted set of these criteria which had gone through a preliminary adaptation to current Thai decision priorities before the workshop, by the local leadership team of the initiative (Step 1). This involved a detailed moderated discussion of each of the criteria and of the measures used for scoring each of the criteria (Step 2).

Subsequently, the participants determined the weight of the price criterion (Step 3) in the overall decision and the acceptable price range and cutoff point qualifying a product for positive ratings on the price criterion (Step 4). After this, the relative importance of each of the criteria in the overall decision was determined following the modified simple multi-attribute rating technique (SMART) method [9] for ranking and swing weighting of the criteria (Step 5). Steps 3–5 included anonymous voting by the participants using an audience response system (Ombea® with OMBEA ResponsePad™). The results of each voting were shown directly to the audience. In case of large variations or disagreements between the voters, the arguments of the participants in support of their votes were deliberated in open discussion followed by a second voting. For the voting on price and the cutoff point, the result was computed by assessing the median value. For the ranking of the criteria, the majority vote was used in repeated voting rounds to select the most important of the remaining criteria.

An important step after the workshop will be the testing and validation of the tool in a realistic setting (piloting) with monitoring of the results, the revision based on the learnings during the pilot, and, finally, the full implementation as summarized in the right part of **Figure 1**.
