The document summarizes responses from experts to key points raised about using multi-criteria decision analysis (MCDA) for health care decisions. Some of the main points made are: - MCDA should not be assumed to always be the right solution and needs to be appropriate for the specific decision context. - Iterative development and validation of MCDA models is important. - MCDA can improve decision making if done rigorously and informed by the wider MCDA literature, learning from common mistakes. - Future work should develop recommendations for typical health decision problems and address non-trivial issues specific to different decision types.

1. 1
Respondents
Nancy Devlin, PhD
Office of Health Economics
London, UK
Praveen Thokala, MASc, PhD
University of Sheffield
Sheffield, UK

2. 2
Key points (1)
Hauber Taskforce Response
‘One should not automatically assume
MCDA is the right solution’
• Agreed. MCDA should be used to assist complex decisions
• Institutional resource constraints are relevant
‘How good is good enough?’ • Anything which improves decision making process is a good thing
• e.g developing/reporting the performance matrix better than nothing
‘What are the implications of
introducing new criteria into repeated
decisions, where consistency is
important?’
• Good question. The process unlikely to remain static forever
• However, same issue encountered in existing approaches?
‘Opportunity cost – still to be figured
out’
• Agreed. Various ways in which cost and opportunity cost might be addressed
in use of MCDA for decisions that affect allocation of limited budgets
‘Does the use of software reduce
transparency?’
• No – it shouldn’t, in fact the software can be used for validation at each step,
which can enhance transparency
• It is the methods underpinning the software, rather than the software per
se, that may seem obscure
Key points (2)
Oliviera Taskforce Response
‘Design of the socio-technical process
matters’
• Agreed. MCDA processes should support – not dictate – the approach taken
in decision making
• Should be appropriate to the specific nature of the decision context
‘Iterative MCDA model development
important’
• Agreed – and we emphasise the need to validate each element of the
process; and to do scenario analysis
‘Focus effort on common mistakes’ • Agreed. Trade-offs are critical to MCDA
• Should learn from MCDA literature and avoid mistakes
MCDA in health care should be
informed by the wider MCDA literature
• Agreed. Definitely. Yes!
Develop recommendations for most
typical decision problems
• Agreed. We think there is more that can and should be done
If we’re going to do MCDA, lets commit
to rigour.
• Agreed. MCDA still relatively new to the health care sector
• There are theoretical and methodological issues to explore

3. 3
Where do we go from here?
• Taskforce reports 1 & 2 will be published in Value in
Health in 2016.
• The checklist in report 2 is, in keeping with our remit,
broadly applicable to decisions in the health care sector.
• But clearly there are non-trivial issues which are specific
to different types of decisions
– HTA: opportunity cost
– BRA, SDM, etc
• We hope to submit new decision-specific MCDA
Taskforce proposals in 2016.