Multiple Criteria Decision Analysis for Health Technology Assessment Report by the Decision Support Unit

Acknowledgements The author is grateful for financial support from the NICE Decision Support Unit (DSU). NICE had no responsibility or control over the content of this paper. This paper aims to look at the applicability of multi criteria decision analysis (MCDA) for health technology assessment. MCDA is aimed at supporting decision makers faced with evaluating alternatives, taking into account multiple, and often conflictive, criteria. This manuscript begins with a critical review of state-of-the-art methods for incorporating multiple criteria in health technology assessment (HTA). An overview of MCDA is provided and is compared against the current NICE (National Institute for Health and Clinical Excellence) health technology appraisal process. A generic MCDA modelling approach is described and the most common types of MCDA models are detailed. The different MCDA modelling approaches are applied to a hypothetical case study. Finally, the issues that need to be considered for the application of MCDA in HTA are examined along with recommendations for future research. Most of the proposed MCDA approaches in literature use the same technique (weighted sum approach) which may lead to the researchers/health professionals assuming that it is the only relevant MCDA method. MCDA does not just stop at simple weighting and scoring; more flexible approaches are available that appear to be more relevant to the NICE appraisal process and value based pricing (VBP). There is a semblance between main MCDA modelling approaches and other techniques (such as programme budgeting and marginal analysis [PBMA], VBP and NICE recommended table of the summary characteristics). However, there are general practical issues that might arise from using an MCDA approach in the HTA process and it is suggested that appropriate care needs to be taken to address the issues identified in order to ensure the success of MCDA techniques in the appraisal process.