Making Good Decisions in Healthcare with Multi-Criteria Decision Analysis: The Use, Current Research and Future Development of MCDA

Abstract

Healthcare decision making is usually characterized by a low degree of transparency. The demand for transparent decision processes can be fulfilled only when assessment, appraisal and decisions about health technologies are performed under a systematic construct of benefit assessment. The benefit of an intervention is often multidimensional and, thus, must be represented by several decision criteria. Complex decision problems require an assessment and appraisal of various criteria; therefore, a decision process that systematically identifies the best available alternative and enables an optimal and transparent decision is needed. For that reason, decision criteria must be weighted and goal achievement must be scored for all alternatives. Methods of multi-criteria decision analysis (MCDA) are available to analyse and appraise multiple clinical endpoints and structure complex decision problems in healthcare decision making. By means of MCDA, value judgments, priorities and preferences of patients, insurees and experts can be integrated systematically and transparently into the decision-making process. This article describes the MCDA framework and identifies potential areas where MCDA can be of use (e.g. approval, guidelines and reimbursement/pricing of health technologies). A literature search was performed to identify current research in healthcare. The results showed that healthcare decision making is addressing the problem of multiple decision criteria and is focusing on the future development and use of techniques to weight and score different decision criteria. This article emphasizes the use and future benefit of MCDA.

Development of the WHO-INTEGRATE evidence-to-decision framework: an overview of systematic reviews of decision criteria for health decision-making

“…The criteria used across different types of decisions have been addressed in multiple reviews. Several reviews have explored the criteria used when applying multi-criteria decision analysis (MCDA) [13,[23][24][25][26][27][28], an"umbrella term to describe a collection of formal approaches which seek to take explicit account of multiple criteria in helping individuals or groups explore decisions that matter" [29]. Other reviews have explored the criteria employed in the context of health technology assessments (HTA), which intend to examine social, economic, organizational and ethical considerations in relation to health technologies in a comprehensive manner [30]; these covered both the criteria to inform decisions about health technologies by national or sub-national HTA institutions [19,[31][32][33], and the criteria used for selecting the technologies or interventions a HTA is to be conducted on [8,34].…”

Resilient supplier selection in logistics 4.0 with heterogeneous information

“…Multi-Criteria Decision Analysis (MCDA) approaches are widely adopted in the fields of transportation, immigration, education, investment, environment, energy, defense and healthcare (Devlin, Sussex, & Economics, 2011;Dodgson, Spackman, Pearman, & Phillips, 2009;Gregory et al, 2012;Mühlbacher, Kaczynski, & policy, 2016;Nutt, King, & Phillips, 2010;Wahlster, Goetghebeur, Kriza, Niederländer, & Kolominsky-Rabas, 2015). Howard and Ralph (Raiffa & Keeney, 1975) first introduce MCDA as a methodology for evaluating alternatives based on individual preference, often against conflicting criteria, and combining them into one single appraisal.…”

Does MCDA Trump CEA?

“…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].…”