Multiple Criteria Decision Analysis (MCDA) in Health Technology Assessment: Review of Literature on MCDA Methodology and Decision Criteria
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Objectives: Many studies are being conducted around the globe to assess the feasibility of multiple criteria decision analysis (MCDA) in health technology assessment (HTA). In this review, we assessed MCDA methodologies and decision criteria used in HTA. Methods: A total of 35 studies published from 2005−2015 that applied MCDA in HTA were selected and the following areas were reviewed: 1) Context of the decision making: decision making setting, level (e.g., micro, meso, macro), and the assessment target (e.g., healthcare policy, drugs, health program, medical test, medical device, treatment, or surgery), 2) MCDA methodology: type of MCDA technique, weighting method, criteria elicitation method, and the participants, 3) Decision criteria: feasibility, social/population impact, intervention related factors, patient/individual-centered values, budget impact, and quality of evidence, and 4) Transparency of the decision making process: the process was considered transparent if the study disclosed the weight of each criterion, the formula used to calculate the final score or if the weighting/calculation method was well explained to the level considered acceptable by the authors. Results: Of the studies reviewed, 63.9% used MCDA for decision making at a national level, and the type of HT being assessed was most often national/regional healthcare policy (44.1%). The most prevalent method of weighting was direct weighting using scales (40.0%). Most of the studies (80.0%) conducted group discussions for criterion selection, and among the criteria, intervention-related factors such as safety and efficacy (93.9%) were most often observed, followed by budget-impact (81.8%) and patient/individual-centered values (81.8%). Conclusion: Substantial demands for incorporation of patient-centered values into the current HTA process were observed. Additionally, MCDA may be a useful tool in incorporating such values to the HTA decision framework, but unresolved methodological issues remain. Further assessment on the application of MCDA in HTA should be conducted for Korea-specific settings.
Abstract
Objectives: Many studies are being conducted around the globe to assess the feasibility of multiple criteria decision analysis (MCDA) in health technology assessment (HTA). In this review, we assessed MCDA methodologies and decision criteria used in HTA. Methods: A total of 35 studies published from 2005−2015 that applied MCDA in HTA were selected and the following areas were reviewed: 1) Context of the decision making: decision making setting, level (e.g., micro, meso, macro), and the assessment target (e.g., healthcare policy, drugs, health program, medical test, medical device, treatment, or surgery), 2) MCDA methodology: type of MCDA technique, weighting method, criteria elicitation method, and the participants, 3) Decision criteria: feasibility, social/population impact, intervention related factors, patient/individual-centered values, budget impact, and quality of evidence, and 4) Transparency of the decision making process: the process was considered transparent if the study disclosed the weight of each criterion, the formula used to calculate the final score or if the weighting/calculation method was well explained to the level considered acceptable by the authors. Results: Of the studies reviewed, 63.9% used MCDA for decision making at a national level, and the type of HT being assessed was most often national/regional healthcare policy (44.1%). The most prevalent method of weighting was direct weighting using scales (40.0%). Most of the studies (80.0%) conducted group discussions for criterion selection, and among the criteria, intervention-related factors such as safety and efficacy (93.9%) were most often observed, followed by budget-impact (81.8%) and patient/individual-centered values (81.8%). Conclusion: Substantial demands for incorporation of patient-centered values into the current HTA process were observed. Additionally, MCDA may be a useful tool in incorporating such values to the HTA decision framework, but unresolved methodological issues remain. Further assessment on the application of MCDA in HTA should be conducted for Korea-specific settings.
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