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Value Health. 2019 Nov;22(11):1283-1288. doi: 10.1016/j.jval.2019.06.014. Epub 2019 Oct 16.

Multicriteria Decision Analysis to Support Health Technology Assessment Agencies: Benefits, Limitations, and the Way Forward.

Author information

1
Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: rob.baltussen@radboudumc.nl.
2
Evidera, London, England, UK.
3
University of Sheffield, Sheffield, England, UK.
4
Florida Agricultural and Mechanical University, Tallahassee, FL, USA.
5
Management Sciences for Health, Arlington, VA, USA.
6
Belgian Health Care Knowledge Centre, Brussels, Belgium.
7
Office of Health Economics, London, England, UK.
8
Medical University of Plovdiv, Plovdiv, Bulgaria; Institute for Rare Diseases, Plovdiv, Bulgaria.
9
Tehran University of Medical Sciences, Tehran, Iran.
10
University of York, York, England, UK.
11
University of Strathclyde, Glasgow, Scotland.
12
Lombardia Regional Health Directorate, Milan, Italy.
13
University of Twente, Enschede, The Netherlands.
14
Roche, Basel, Switzerland.
15
LASER Analytica, Montreal, Canada.
16
Mahidol University, Bangkok, Thailand.
17
ZRx Outcomes Research Inc, Mississauga, Canada.
18
Radboud University Medical Center, Nijmegen, The Netherlands.

Abstract

OBJECTIVE:

Recent years have witnessed an increased interest in the use of multicriteria decision analysis (MCDA) to support health technology assessment (HTA) agencies for setting healthcare priorities. However, its implementation to date has been criticized for being "entirely mechanistic," ignoring opportunity costs, and not following best practice guidelines. This article provides guidance on the use of MCDA in this context.

METHODS:

The present study was based on a systematic review and consensus development. We developed a typology of MCDA studies and good implementation practice. We reviewed 36 studies over the period 1990 to 2018 on their compliance with good practice and developed recommendations. We reached consensus among authors over the course of several review rounds.

RESULTS:

We identified 3 MCDA study types: qualitative MCDA, quantitative MCDA, and MCDA with decision rules. The types perform differently in terms of quality, consistency, and transparency of recommendations on healthcare priorities. We advise HTA agencies to always include a deliberative component. Agencies should, at a minimum, undertake qualitative MCDA. The use of quantitative MCDA has additional benefits but also poses design challenges. MCDA with decision rules, used by HTA agencies in The Netherlands and the United Kingdom and typically referred to as structured deliberation, has the potential to further improve the formulation of recommendations but has not yet been subjected to broad experimentation and evaluation.

CONCLUSION:

MCDA holds large potential to support HTA agencies in setting healthcare priorities, but its implementation needs to be improved.

KEYWORDS:

HTA agencies; multicriteria decision analysis; priority setting; value framework

PMID:
31708065
DOI:
10.1016/j.jval.2019.06.014
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