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Using MCDA as a Decision Aid in Health Technology Appraisal for Coverage Decisions: Opportunities, Challenges and Unresolved Questions

Abstract

Existing Health Technology Appraisal (HTA) processes almost inevitably require the consideration of multiple criteria which go beyond improvements in patient and population health. MCDA offers a way of structuring these decision processes and making them more transparent and consistent. Its use represents a way of complementing and supporting deliberative processes, rather than supplanting them. This can also assist the accountability of HTA decisions to stakeholders.

MCDA has the potential to address a number of limitations of current HTA systems. However, its application in HTA requires careful consideration of a number of issues, including how the decision criteria are selected and weighted; whose values should be used; how budget constraints and opportunity costs are addressed; and how uncertainty in evidence is handled. The way forward on these fundamental questions will depend on the type of the decision problem and of the objectives of the health-care system within which decisions are being made.

There needs to be a consideration of the balance between additional organisational costs of implementing an MCDA approach and additional benefits of improved decision making process. Even where MCDA cannot follow ‘best practise’, partial implementation (e.g. use of a performance matrix) may still have the potential to improve the decision making process.

Keywords

  • Decision Maker
  • Multiple Criterion
  • National Health System
  • Allocative Efficiency
  • Deliberative Process

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Fig. 14.1

Notes

  1. 1.

    An exception is the Swedish approach to HTA, which stipulates a preference for using patients’ ‘experience-based’ values, rather than those of the general public, in the valuation of quality of life.

  2. 2.

    ‘The A4R framework consists of four conditions: process must be public (fully transparent) about the grounds for its decisions; the decision must rest on reasons that stakeholders can agree are relevant; decisions should be revisable in light of new evidence and arguments; and there should be assurance through enforcement that these conditions (publicity, relevance, and revisability) are met’ (Norman and Sabin <CitationRef CitationID="CR36" >2008</Citation Ref>).

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Acknowledgements

The authors would like to thank Adrian Towse, Grace Marsden, Hector Castro and the editors for their valuable comments received on an early draft of this chapter.

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Correspondence to Martina Garau .

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Garau, M., Devlin, N.J. (2017). Using MCDA as a Decision Aid in Health Technology Appraisal for Coverage Decisions: Opportunities, Challenges and Unresolved Questions. In: Marsh, K., Goetghebeur, M., Thokala, P., Baltussen, R. (eds) Multi-Criteria Decision Analysis to Support Healthcare Decisions. Springer, Cham. https://doi.org/10.1007/978-3-319-47540-0_14

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  • DOI: https://doi.org/10.1007/978-3-319-47540-0_14

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