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

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.