Does MCDA Trump CEA?

Abstract

A growing amount of literature claims that multicriteria decision analysis (MCDA) is superior to economic evaluation in health technology assessment (HTA). The main arguments are that (1) MCDA includes a comprehensive and explicit list of value criteria not captured by the traditional methods of economic evaluation; (2) since it allocates quantitative weights to the different evaluation criteria, their relative importance is incorporated explicitly in the evaluation, thus making values and elicited preferences more consistent and transparent; and (3) the participation of all agents involved in assessing the value of alternatives increases the legitimacy of the process [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Arguments against MCDA include the inadequate treatment of opportunity cost, its vulnerability to double counting, and the fallacious attribution of deficiencies to methods of economic evaluation (EA) like cost-effectiveness analysis (CEA) in HTA [13][14][15][16][17][18][19][20][21][22][23][24]. We do not consider further the third argument for MCDA, because such participation seems to be a standard element of good practice in CEA [25][26][27][28][29][30][31][32].

The Broader Opportunity Costs in the Broader Cost-Effectiveness Analysis Framework

“…However, these frameworks either fail at providing an aggregated measure, focussing instead on displaying outcomes in a disaggregated manner or fail at accounting for opportunity costs, both related to health and/or to any other dimension, or they fail at both. In addition, some of these previously proposed frameworks involves qualitatively eliciting values from specific stakeholders at each decision-specific context, and are at a high risk of double counting [55]. In contrast, the proposed framework seeks to provide an alternative based on empirical evidence to methods requiring decisions to be based on the value judgements of a small number of stakeholders, different at each decision, which introduce arbitrariness, subjectivity and inconsistency into decision making, and that most often ignore "the patient not in the room" [56].…”

Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis?

“…By including costs as a criterion, it is argued that the opportunity costs are not addressed adequately in the MCDA; therefore, costs should not be included. [59][60][61][62] However, an argument in favor of including costs in the MCDA, just like the other criteria, is that the relative contribution of costs to the decisionmaking process is made more explicit. 51 Additionally, when implementing new models of care, reducing costs is one of the aims on new models of care, alongside improving quality of and access to care.…”

Design of a multiple criteria decision analysis framework for prioritizing high-impact health technologies in a regional health service

“…A classical definition of MCDA is that by Keeny and Raiffa (21), “a methodology for appraising alternatives on individual, often conflicting criteria, and combining them into one overall appraisal.” The potential of MCDA in healthcare decision making was recognized in the 1980s and, since then, the use of MCDA in health technology assessment (HTA) has been actively promoted, based on its potential, but also criticized, because of doubts about its suitability (22). Nevertheless, MCDA has been widely utilized in the healthcare sector for various decision-making purposes (23;24), such as new technology evaluations (25;26), assessment of orphan drugs (27;28), risk–benefit assessments (29), hospital purchasing (30–33), and establishing priority frameworks for different types of interventions (34;35).…”