Multi-criteria decision analysis (MCDA) is increasingly used to support healthcare decision-making. MCDA involves decision makers evaluating the alternatives under consideration based on the explicit weighting of criteria relevant to the overarching decision—in order to, depending on the application, rank (or prioritize) or choose between the alternatives. A prominent example of MCDA applied to healthcare decision-making that has received a lot of attention in recent years and is the main subject of this article is choosing which health “technologies” (i.e., drugs, devices, procedures, etc.) to fund—a process known as health technology assessment (HTA). Other applications include prioritizing patients for surgery, prioritizing diseases for R&D, and decision-making about licensing treatments. Most applications are based on weighted-sum models. Such models involve explicitly weighting the criteria and rating the alternatives on the criteria, with each alternative’s “performance” on the criteria aggregated using a linear (i.e., additive) equation to produce the alternative’s “total score,” by which the alternatives are ranked. The steps involved in a MCDA process are explained, including an overview of methods for scoring alternatives on the criteria and weighting the criteria. The steps are: structuring the decision problem being addressed, specifying criteria, measuring alternatives’ performance, scoring alternatives on the criteria and weighting the criteria, applying the scores and weights to rank the alternatives, and presenting the MCDA results, including sensitivity analysis, to decision makers to support their decision-making. Arguments recently advanced against using MCDA for HTA and counterarguments are also considered. Finally, five questions associated with how MCDA for HTA is operationalized are discussed: Whose preferences are relevant for MCDA? Should criteria and weights be decision-specific or identical for repeated applications? How should cost or cost-effectiveness be included in MCDA? How can the opportunity cost of decisions be captured in MCDA? How can uncertainty be incorporated into MCDA?
Economic evaluations of health technologies in Dutch healthcare decision-making: a qualitative study of the current and potential use, barriers, and facilitators
