Applying the Analytical Hierarchy Process to global health decision making: Active pharmaceutical ingredient – technology (API-tech) mapping case studies, lessons learned, and opportunities

Abstract The Analytical Hierarchy Process (AHP) is a well-established decision science tool that has been widely applied across various sectors. Despite the pervasiveness of AHP across many industries, there is limited documented evidence of this methodology being applied to global health contexts. The purpose of this study was to demonstrate how AHP can be applied to global health challenges, specifically to prioritize investments in pediatric antibiotics and antiretrovirals. The Expert Choice ComparionTM software was used to build AHP surveys to achieve the goal of prioritizing age-appropriate formulations according to how effectively they meet the desired product attributes. The AHP surveys were disseminated to community members, clinicians, and programmatic experts to provide input on the relative importance of the product attributes and products by responding to pairwise and Likert-based questions. Results were subsequently analyzed and interpreted using Expert Choice. Results from the pediatric antibiotics AHP survey revealed that standard oral dosage forms, microarray patches, and oral films were similarly high priority across pediatric sub-populations. For the pediatric HIV AHP survey, oral films, injectables, and microarray patches were top scoring platforms across pediatric sub-populations, with implant-depot formulations also scoring highly for older children. The AHP findings were used to develop product-specific roadmaps and calls to action for how donors, developers, and other key stakeholders should prioritize investments to accelerate development of the most promising technologies. The successful utilization of AHP in this study provides an evidence base on applying this methodology to define investment priorities in global health settings. These findings suggest that there may be an opportunity for broader use of AHP in global health to support resource allocation, investment prioritization, and program implementation amidst an uncertain and constrained global health funding landscape. Competing Interest Statement CRST, MJL, MW, and PD have declared NO competing interests. EF's competing interests include ownership of stocks or shares at Expert Choice and patent applications associated with the Expert Choice Comparion software. HF's competing interests include paid employment or consultancy at Expert Choice. We confirm that these competing interests will not alter adherence to our target journal policies on sharing data and materials. Funding Statement The work included in this submission was funded by WHO/GAP-f (https://www.who.int/initiatives/gap-f, award #2023/1386650) and Unitaid (https://unitaid.org/, award #2016-05-CHAI). CST, ML, MW, and PD received these awards. There were no commercial sources of funding for this work. The funding sources played a role in the decision to publish. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The research was exempt from IRB approval. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data for this manuscript can be accessed in the attached Supporting Information file. See S1 Dataset.