MCDA-based deliberation to value health states: lessons learned from a pilot study

Abstract

Background Health economists have shown a growing interest in deliberation and multi-criteria decision analysis (MCDA) as possible pathways to transparently integrate value judgments in cost-utility analyses. In line with these developments, this study piloted a consensus process to derive a German value set for the Short-Form Six-Dimension (SF-6D). In a conference setting, a group was tasked to deliberate on scores and weights for the SF-6D from the perspective of a self-determined and independent life. Methods The one-day consensus conference was based on a deliberative process in combination with the MCDA method MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique). According to MACBETH, participants were asked to qualitatively rate pairwise comparisons of SF-6D health states. The scoring within each dimension was conducted in parallel group sessions. Final agreement on the scores as well as weights for the SF-6D dimensions were derived in a subsequent plenary assembly. Results were analyzed using the software M-MACBETH and qualitative content analysis. Results A total of 34 participants were recruited. While each of the 6 small groups presented a consented score, the plenary assembly reached consensus on all dimensions apart from pain. Concerning dimension weights, some participants favored prioritizing pain and mental health. Others disputed that trade-offs between dimensions and thus assigning weights were not acceptable in a context where this may involve withholding care from someone. As a consequence, no consensus on a value set was reached. Participants identified the group size of the plenary session and the applied weighting procedure as main obstacles to the process. Conclusions This pilot study presents a consensus-based approach for valuing health-related quality of life. However, further research is needed on deliberative processes that yield quantifiable results. Future conferences should explore smaller group sizes, longer durations of the deliberative process and alternatives to the additive value function applied in MACBETH. Electronic supplementary material The online version of this article (10.1186/s12955-019-1189-7) contains supplementary material, which is available to authorized users.

Reasoning in the valuation of health‐related quality of life: A qualitative content analysis of deliberations in a pilot study

“…To discuss the feasibility of eliciting public reasons for valuation decisions on health states using deliberation, the following section focuses on three key issues: the main themes on reasoning identified in the deliberations, the perspective of these reasons and the suitability of a deliberative setting to elicit public reasons. A detailed discussion of the methodology applied in the pilot study is presented in Gansen et al…”

“…These recordings were transcribed verbatim following a uniform standard . The participants’ comments in the debriefing questionnaire were not included in the part of the QCA relevant to this article . The QCA was implemented with the software MAXQDA 2018.…”

“…Based on a pilot study, this article examines the reasons participants give for their valuations of the SF‐6D in public deliberation. An exhaustive analysis of the applied methodology including details on the valuation approach MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) is presented elsewhere . In short, MACBETH is a method of multi‐criteria decision analysis (MCDA) which uses only qualitative judgements to derive numerical valuations .…”

“…An exhaustive analysis of the applied methodology including details on the valuation approach MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) is presented elsewhere. 8 In short, MACBETH is a method of multi-criteria decision analysis (MCDA) which uses only qualitative judgements to derive numerical valuations. 9 While MACBETH has been used in various settings within and beyond health care, 10,11 MCDA techniques have also been applied successfully in the valuation of HRQOL.…”

Social tariffs and democratic choice – do population-based health state values reflect the will of the people?

“…Instead, public deliberations would be required to derive an adequate information basis for economic evaluations. I would argue that, at the very least, participants in health state valuation studies should be given the opportunity to reflect on their responses and to seek additional information about the health states they are not familiar with (Devlin et al, 2019;Gansen et al, 2019).…”