Using MCDA to generate and interpret evidence to inform local government investment in public health

Abstract

Smoking is the single biggest cause of preventable death in the Uited Kingdom (UK) and is a major cause of coronary heart disease, some cancers, and respiratory disease, including chronic obstructive pulmonary disease. At the time of initiating the project, smoking prevalence had not changed across four local government areas in South Yorkshire for some years. Most spending had been focussed on helping people quit, an intervention where there was clear evidence of effectiveness. A number of changes occurred in public health structures and targets, requiring a reappraisal of the range of interventions offered. This was challenging due to a lack of clear evidence for some of the areas' alternative interventions. The aim of this paper is to describe the use of a multi-criteria decision analysis (MCDA) approach to support the health priority setting in local authorities to reduce smoking prevalence. There were three phases to this process: (1) problem structuring; (2) the multiple criteria decision analysis; (3) and using the MCDA results to influence decision making at the local government level. The MCDA approach was used to collate information in a consistent and transparent manner, using expert, stakeholder and public opinion to fill known gaps in evidence. Fifteen interventions (such as stop smoking support services, smoke-free spaces, communication and marketing exercises, and increased investment in enforcement) were ranked across eight criteria (relating to reductions in prevalence across relevant groups, as well as aspects relating to equity and feasibility), allowing a range of relevant concerns to be incorporated. Subsequent steps were taken to translate the results of this stage into workable policy options. The results differed significantly from current practice. Sensitivity analysis showed that the findings were robust to changes in preference weights. These results informed subsequent changes to the interventions offered across the four boroughs. The ability of MCDA techniques to incorporate data and both qualitative and quantitative judgements in a formal manner mean that they are well suited to support public health decision making, where evidence is often only partially available and many policies are value driven. MCDA methods, if used, should be chosen carefully based on their resource/time constraints, scientific validity, and the significance and broader context of the decision problem.Keywords MCDA Á Public health policy Á Health economics Á Tobacco interventions Á Evidence-based decision making BackgroundSmoking is the single biggest cause of preventable death in the United Kingdom (UK). Smoking is a major cause of coronary heart disease, some cancers and respiratory disease, including chronic obstructive pulmonary disease. These diseases have the greatest impact on the least well off in society and it is estimated that up to half the difference in premature death between the most and least affluent groups is explained by different patterns in smoking (Jarvis and Wardle 1999). Despi...

Developing composite indices of geographical access and need for nursing home care in Ireland using multiple criteria decision analysis

“…These fall into the broad groups of value measurement, outranking and goal programming 19 . No single approach is perfect for every decision problem, and choice of MCDA method should be based on resource/time constraints, scientific validity and the significance and broader context of the decision problem 11 .…”

“…MCDA techniques can be used to better structure complex decision problems 10 , increase transparency 11 and avoid the problems associated with using heuristic approaches to solve decision problems involving complex trade-offs 12 . MCDA approaches have been used in a wide range of health settings and their use has grown in recent years 13 , 14 .…”

A role for MCDA to navigate the trade-offs in the National Institute for Health and Care Excellence’s public health recommendations

“…The design of the approach to be used should be based what is achievable given the strictures on the decision and must be carefully designed within such bounds [9]. To impose the 'best' approaches to use without knowing the exact context in which decision-makers wished to use them would be inflexible and unnecessarily dogmatic.…”

“…There has been increasing academic interest in attempting to use multiple criteria decision analysis (MCDA) approaches to help guide the decision-making processes used in health care prioritisation for some years [5][6][7][8] . Public health decision-making is potentially a very suitable area to investigate the application of MCDA approaches, both due its supposed 'weaknesses' -MCDA can offers new ways to both generate evidence [9] and quantify value judgements [9] but also because of its strengths -public health interventions' consistent costeffectiveness [4] could make it a low risk setting to investigate and pilot potential approaches in the National Institute for Health and Care Excellence (NICE). Successful approaches could if desired thereafter be employed across NICE appraisals, leading to more rationalor at least more transparentprocesses for public health appraisals in future.…”

Introduction to the special issue

“…The four papers included in this special issue directly address that mission. Reddy et al (2016) present a multicriteria intervention to assist prioritisation of smoking cessation interventions in England, reminding us that decision support models do not need technical sophistication but do require substantial input from stakeholders. Flessa et al (2016) also present a policy model, but in their case, the model is an infectious disease model of the Human Papilloma Virus (HPV) which causes cervical cancer, and the country concerned is Cambodia.…”