MCDA can help address some challenges in health technology assessment by systematically considering multiple criteria, such as health impacts, costs, equity and other value dimensions. Some countries have piloted the use of MCDA in HTA processes, but there are still open questions around which criteria and weights to use, how to incorporate opportunity costs and deal with uncertainty. While MCDA shows promise for improving transparency and decision-making in HTA, further work is needed to balance its benefits and costs for different healthcare systems.
Are Wider Societal Effects Considered in Healthcare Decision-making? An over...Office of Health Economics
Presentation at ISPOR Italy - 12.04.16 - Are Wider Societal Effects Considered in Healthcare Decision-making? An overview from other countries by Martina Garau, OHE
Are Wider Societal Effects Considered in Healthcare Decision-making? An over...Office of Health Economics
Presentation at ISPOR Italy - 12.04.16 - Are Wider Societal Effects Considered in Healthcare Decision-making? An overview from other countries by Martina Garau, OHE
Data Governance for Real-World Evidence: Cross-country differences and recommendations for a governance framework
Cole, A., Garrison, L., Mestre-Ferrandiz, J. & Towse A.
High-cost, innovative pharmaceuticals are one serious challenge for health care systems today. At a panel that explored how this might be addressed in Asia, Adrian identified the issues and discussed the potential role of managed entry agreements (MEAs) and performance-based risk-sharing arrangements (PBRSAs). In essence, these measures allow a new medicine to be marketed while additional data about its use in actual clinical practice are being collected. Implementing MEAs or PBSRAs can be difficult, he notes. Crucial to success are assessing local value and ensuring that measures are based on formal written agreements that clealry set out expectations and responsibilities for all stakeholders.
Health technology assessment (HTA) is familiar as technique for gauging the value of specific medical technologies or approaches to care. As Adrian Towse points out, however, HTA has a much broader, ‘macro’ role in contributing to the efficiency of health care systems and supporting universal health coverage. This is particularly crucial in the face of increasing demands and limited budgets.
Data Governance for Real-World Evidence: Cross-country differences and recommendations for a governance framework
Cole, A., Garrison, L., Mestre-Ferrandiz, J. & Towse A.
High-cost, innovative pharmaceuticals are one serious challenge for health care systems today. At a panel that explored how this might be addressed in Asia, Adrian identified the issues and discussed the potential role of managed entry agreements (MEAs) and performance-based risk-sharing arrangements (PBRSAs). In essence, these measures allow a new medicine to be marketed while additional data about its use in actual clinical practice are being collected. Implementing MEAs or PBSRAs can be difficult, he notes. Crucial to success are assessing local value and ensuring that measures are based on formal written agreements that clealry set out expectations and responsibilities for all stakeholders.
Health technology assessment (HTA) is familiar as technique for gauging the value of specific medical technologies or approaches to care. As Adrian Towse points out, however, HTA has a much broader, ‘macro’ role in contributing to the efficiency of health care systems and supporting universal health coverage. This is particularly crucial in the face of increasing demands and limited budgets.
Technologies that enhance the precision and effect of therapies can make a critical contribution to ensuring value for money and improving patient care. Methods and processes for assessing value, however, still are imperfect. This presentation reviews the challenges and identifies some approaches for meeting them.
OHE’s Professor Nancy Devlin has researched, written and spoken widely on the use of the EQ-5D, and related measures, both in her capacity as the Director of Research at the OHE and as Chair of the Executive Committee of the EuroQol Group.
In May, Nancy was invited to participate in the “Workshop on measuring patient-reported outcomes using the EQ-5D”, which was organised by the Swedish National Board of Health and Welfare in collaboration with the EuroQol Group. The workshop brought together policy makers and researchers in Sweden interested in measuring patients’ health outcomes.
Sweden has included the EQ-5D in some of its quality registries and in population health surveys for many years. The Swedish National Board of Health and Welfare now is exploring whether and how to extend use of patient reported outcomes measures in the health care system, including the EQ-5D, to both monitor the quality of providers and services and to facilitate health technology appraisal.
Nancy’s talk, shown below, introduced the EQ-5D instrument; discussed how data from it can be analysed; identified some of the challenges in analysis; and commented on the future of outcomes measurement.
‘In with the old, out with the new’ – In search of ways to help health economists break their addiction to technology adoption. CHE Seminar presented by Professor Stirling Bryan, Director, Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Professor, School of Population & Public Health, University of British Columbia. 17th October 2014
Top 3 Strategic Initiatives for Sustainable Results in Healthcare in Middle EastSTELIOS PIGADIOTIS
This research paper offers insights in three areas:
1. Current Challenges in GCC/Middle East Healthcare sector
2. Future Drivers for Healthcare Excellence
3. Future Strategic Initiatives for Sustainable Results
Presentation by David Wonderling, Head of Health Economics at National Guideline Centre, Royal College of Physicians and Lauren Ramjee, Senior Health Economist, Royal College of Physicians.
This workshop outlines the principles of health economic evaluation for the NHS.
Placing the Evolution of HTA In Emerging Markets in Context of Health System ...Office of Health Economics
These slides were presented by Professor Adrian Towse at the 9th World Congress of the International Health Economics Association in July 2013. The presentation examined how the development of health care systems affect the evolution of the use of health technology assessment. Three countries provide case studies: Brazil, China and Taiwan.
On 31 October 2019, Adrian Towse and Chris Henshall from the Office of Health Economics (OHE) presented at the G20 meeting on antimicrobial drugs R&D in Paris organised by the Wellcome Trust. The topic of their presentation was HTA and payment mechanisms for new drugs to tackle antimicrobial resistance.
This presentation looks at ways in which governments can set prices, including “cost plus”, value, and the external referencing of prices elsewhere. It looks at the role that competition can play in keeping down prices. In that context it briefly discusses pricing proposals being considered in Malaysia. It makes the case for using HTA to inform pricing decisions.
Adrian Towse
% GDP spending in UK, G5 countries and OECD upper middle income countries. W...Office of Health Economics
This presentation looks at rates of GDP spend on health care, distinguishing between categories of country (i.e. levels of GDP pre capita). It looks at the relationship between rates of spending and moves to universal health coverage, and explores alternative ways of increasing expenditure and making decisions about which services to provide with the money available.
The role of real world data and evidence in building a sustainable & efficien...Office of Health Economics
This presentation defines RWD and RWE in the context of digital health, and looks at potential uses for RWD and RWE. It briefly sets out the current landscape in Malaysia and looks at the challenges in using RWE. In particular, the issues of access, governance and ensuring good quality are considered.
The aim of this educational symposium was to discuss why we should seek value across the health care system and how we can apply existing research methods to measure the value of services. While considerable political attention in developed countries continues to be focused on drug spending, there is also growing awareness of the significant contribution of non-drug components of health care (e.g., hospital services and inefficient care delivery) to overall spending growth and patient affordability. At the same time, there is growing interest in making greater use of value assessment and value-based payment to control spending and better align it with care quality. In order to promote greater value, and to do so in ways that respond to the needs of payers and patients, it is essential to assess value across both drug- and non-drug interventions and health care services. This panel will offer expert viewpoints to identify and discuss gaps in value information, rationale and approaches to track and reduce system-wide low value care, and research methods for how to measure health care services.
Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...Office of Health Economics
Graham participated in an organised session on Monday July 15th 2019. In the session he presented his paper with his co-author Ioannis Laliotis from the London School of Economics. The paper revisits the relationship between workforce and maternity outcomes in the English NHS in an attempt to contribute knowledge to an important policy question for which there has been a paucity of research.
This research explores the feasibility of introducing an Outcome-Based Payment approach for new cancer drugs in England. A literature review explored the current funding landscape in England, the available evidence on existing OBP schemes internationally, and
which outcomes cancer patients value most. Two focus groups and an online survey with patients and carers, as well as interviews with NHS and government stakeholders, healthcare
professionals, and pharmaceutical industry representatives, provided additional evidence on the feasibility and suitability of OBP schemes
Understanding what aspects of health and quality of life are important to peopleOffice of Health Economics
Poster presentation from the EuroQol Plenary Meeting 2019, Brussels, Belgium. By Koonal Shah, Brendan Mulhern, Patricia Cubi-Molla, Bas Janssen, and David Mott.
Koonal presented as part of an organised session on ‘moving beyond conventional economic approaches in palliative and end of life care’. He summarised the empirical evidence on the extent of pubic support for an end of life premium, before discussing some novel approaches that have been used in recent studies. His presentation was discussed by Helen Mason of Glasgow Caledonian University.
Author(s) and affiliation(s): Koonal Shah, Office of Health Economics
Event: iHEA Congress
Date: 17/07/2019
Location: Basel, Switzerland
Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...Office of Health Economics
This research presented in a poster at HTAi 2019, Cologne (Germany) by a team of OHE and IHE researchers, estimates the value added by second generation antipsychotics over their life-cycle in the UK and Sweden. It concludes that considering the entire life-cycle, the value added by SGAs to the system is higher than the expected value estimated at launch. P&R decisions should consider how to measure, capture and take into account the value added by medicines over the long-run.
Author(s) and affiliation(s): Mikel Berdud (Office of Health Economics, London), Niklas Wallin-Bernhardsson (Institute for Health Economics, Stockholm), Bernarda Zamora (Office of Health Economics, London), Peter Lindgren (Institute for Health Economics, Stockholm), Adrian Towse (Office of Health Economics, London)
Event: HTAi 2019 Annual Meeting
Date: 18/06/2019
Location: Cologne, Germany
There is growing recognition that HTA and contracting systems for antimicrobials need to be adapted to help fight the threat of antimicrobial resistance (AMR), but there is little agreement on how. This poster reports findings from a literature review, expert interviews and face-to-face discussions at a Forum on the current HTA and payment systems for antibiotics across Europe and a number of recommendations for adapting these systems to respond to the challenges of AMR.
Author(s) and affiliation(s): Margherita Neri (OHE) Grace Hampson (OHE) Christopher Henshall (OHE visiting fellow, independent consultant) Adrian Towse (OHE)
Event: HTAi annual conference 2019
Date: 18/06/2019
Location: Cologne, Germany
Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...Office of Health Economics
This study aims to guide access decisions and drive the discussion on access and price, through recognition of the dynamic nature of value added by pharmaceutical innovation over the long-run. The analysis of the life-cycle value of risperidone estimates the value generated in the UK and Sweden. Results show that health systems were able to appropriate most of the life-cycle value generated, and this is larger than estimated at launch.
Author(s) and affiliation(s): Mikel Berdud(1), Niklas Wallin-Bernhardsson(2), Bernarda Zamora(1), Peter Lindgren(2), and Adrian Towse(1) (1) Office of Health Economics (2) The Swedish Institute for. Health Economics
Event: XXXIX JORNADAS DE ECONOMÍA DE LA SALUD
Date: 12/06/2019
Location: Albacete, Spain
Prescribed Specialised Services (PSS) Commissioning for Quality and Innovation (CQUIN) schemes were launched in 2013 in England with the aim of improving the quality of specialised care and achieving value for money. During this presentation, Marina Rodes Sanchez described the key features of the schemes and discussed its strengths and weaknesses based on international pay-for-performance literature.
Author(s) and affiliation(s): Yan Feng, Queen Mary University of London; Søren Rud Kristensen, Imperial College London; Paula Lorgelly, King’s College London; Rachel Meacock, University of Manchester; Marina Rodes Sanchez, Office of Health Economics; Luigi Siciliani, University of York; Matt Sutton, University of Manchester
Event: XXXIX Spanish Health Economics Association Conference
Date: 12/06/2019
Location: Albacete, Spain
In this session, Meng Li sets out estimates of real option value for drugs arguing that option value matters and can be calculated. Adrian Towse sets out likely payer concerns about incorporating real option value into decision making. Meng Li responds to these concerns. Jens Grueger sets out how industry considers investment opportunities, arguing that if patients (and society) have preferences these need to be reflected in P&R decisions.
Author(s) and affiliation(s): Meng Li, Postdoctoral Research Fellow, Leonard D Schaeffer Center, University of Southern California, Los Angeles, CA, USA. Adrian Towse, Emeritus Director, Office of Health Economics, London, UK Jens Grueger, formerly Head of Global Access, Senior Vice President at F. Hoffmann-La Roche
Event: ISPOR 2019
Location: New Orleans, USA
Date: 21/05/2019
MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...Office of Health Economics
In this ISPOR session Chuck Phelps and Adrian Towse debated the case for and against using MCDA to support HTA decision making, as compared to weighting or augmenting a QALY based ICER approach. Chuck Phelps argued for use of MCDA, Adrian Towse for weighting the QALY. Nancy Devlin set the scene and moderated.
Author(s) and affiliation(s): Nancy Devlin, Director, Centre for Health Policy, University of Melbourne, Australia Adrian Towse, Emeritus Director, Office of Health Economics, London, UK Chuck Phelps, University of Rochester, Rochester, NY USA
Event: ISPOR 2019
Location: New Orleans, USA
Date: 21/05/2019
This presentation by Morris Kleiner (University of Minnesota), was made during the discussion “Competition and Regulation in Professions and Occupations” held at the Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found out at oe.cd/crps.
This presentation was uploaded with the author’s consent.
Sharpen existing tools or get a new toolbox? Contemporary cluster initiatives...Orkestra
UIIN Conference, Madrid, 27-29 May 2024
James Wilson, Orkestra and Deusto Business School
Emily Wise, Lund University
Madeline Smith, The Glasgow School of Art
0x01 - Newton's Third Law: Static vs. Dynamic AbusersOWASP Beja
f you offer a service on the web, odds are that someone will abuse it. Be it an API, a SaaS, a PaaS, or even a static website, someone somewhere will try to figure out a way to use it to their own needs. In this talk we'll compare measures that are effective against static attackers and how to battle a dynamic attacker who adapts to your counter-measures.
About the Speaker
===============
Diogo Sousa, Engineering Manager @ Canonical
An opinionated individual with an interest in cryptography and its intersection with secure software development.
Acorn Recovery: Restore IT infra within minutesIP ServerOne
Introducing Acorn Recovery as a Service, a simple, fast, and secure managed disaster recovery (DRaaS) by IP ServerOne. A DR solution that helps restore your IT infra within minutes.
Have you ever wondered how search works while visiting an e-commerce site, internal website, or searching through other types of online resources? Look no further than this informative session on the ways that taxonomies help end-users navigate the internet! Hear from taxonomists and other information professionals who have first-hand experience creating and working with taxonomies that aid in navigation, search, and discovery across a range of disciplines.
Getting started with Amazon Bedrock Studio and Control Tower
Using MCDA for HTA, Opportunities, Challenges and Possible Ways Forward
1. Martina Garau and Nancy Devlin
USING MCDA FOR HTA. OPPORTUNITIES,
CHALLENGES AND POSSIBLE WAYS
FORWARD
1
2. Agenda
• Introduction
• Why do we need MCDA in Health Technology
Assessment (HTA)?
• Examples of applications of MCDA in HTA
• Critical issues:
– Criteria and weights need to be ‘fixed’?
– Whose criteria?
– Whose preferences for weighting the criteria?
– How to factor in opportunity cost?
– How can uncertainty be addressed?
• Conclusions This presentation is based on a book chapter
(Garau and Devlin, forthcoming)
2
3. Introduction
• Many countries have developed/are developing collectively-
funded health care systems to ensure universal coverage and
access to health care for their populations
• HTA on individual or groups of technologies can be used to
allocate limited funds efficiently
• However, existing HTA processes vary in their remit and their
objectives
– QALY -maximisers given the budget constraint; explicit or implicit
consideration of opportunity cost of new technologies
– HTA systems which do not consider costs (e.g. US) and focus on
relative/comparative effectiveness
3
4. Why do we need MCDA in HTA? (1)
• Health care systems face multiple objectives that might go beyond
improvements in population health
• HTA systems vary in how far they are explicit and consistent in considering
multiple elements of value
Policy initiatives suggest a need for approaches that could take into
account multiple criteria simultaneously and in a systematic way (e.g. VBA
in the UK; GPS-Health in global context – Norheim et al., 2014)
• Increasingly a wide range of stakeholders, including patients and clinicians, have
been involved in HTA (e.g. PACE in Scotland)
But how do stakeholders’ views influence final decisions?
How can stakeholders views be taken into account in a systematic way and
weigh up against other types of evidence?
4
6. Why do we need MCDA in HTA? (2)
• Weighing up complex information is cognitively demanding
– Literature shows that individuals are subject to “cognitive bias” (add
reference)
– Deliberative processes are influenced by group dynamics and factors
including chairing styles and dominant people
→ “the preferred options identified by MCDA are likely to out-perform the
use of intuitive judgement alone” (Devlin and Sussex, 2011)
6
7. Growing interest in MCDA in HTA
• NICE:
– ‘Structured decision making’ included for the first time in the 2013
methods review
– Exploration of its use in clinical guidelines
– Explicit criteria for new highly specialised technologies process
– Public health
• Some examples of one-off uses but no current systematic use:
– Israeli Health Basket Committee (Golan and Hansen, 2012)
– Italy (Radaelli et al., 2014)
– Thailand (Youngkong et al., 2012)
– Germany (Danner et al., 2011)
7
9. MCDA in Italian region Lombardia
• For the implementation of new health technologies, the
Lombardia region in Italy has introduced a system combining
elements of the EUnetHTA Core model (for the assessment)
and of an MCDA approach (EVIDEM) as a decision-making aid
• The MCDA framework includes 9 broad dimensions and 20
criteria, including disease-, treatment-, financial- and social-
related aspects
• This approach has been deemed successful and used for 26
technologies (Radaelli et al., 2014)
9
11. Thai pilot (2)
• Assessment and appraisal of selected interventions based on
– Value for money (incremental cost effectiveness ratio against a threshold)
– Budget impact
Source: Youngkong et al., 2012
11
12. IQWiG pilots
• Aims were:
– Identifying patient-relevant outcomes in depression and
hepatitis C
– Eliciting patient preferences on the selected outcomes using
two approaches (Analytic Hierarchy Process (AHP) and Discrete
Choice Experiment (DCE))
– Enabling aggregation of outcome-specific efficiency frontiers
based on obtained weights
• Both pilots concluded that MCDA approaches can be
used to support the HTA process to incorporate patient
preferences (Thokala et al., 2016)
12
13. Critical issues
• Criteria and weights need to be ‘fixed’?
• Whose criteria?
• Whose preferences for weighting the criteria?
• How can the opportunity cost of new technologies
be incorporated?
• How can uncertainty be addressed?
13
14. Criteria and weights need to be ‘fixed’?
1. Established in advance; the same across all
decisions
– Allows using same metric to measure lost and added benefit
– Consistency between decisions
– Issue of different scale ranges
2. Chosen on a case-by case basis and varying across
technologies or disease areas
– It can hinder systematic consideration of all criteria and
predictability of decision making process
14
15. Whose criteria?
1. Current HTA bodies’ criteria
– Do they have any legitimacy?
2. Members of an HTA committee on behalf of payers
or NHS budget-holders
– This can encourage alignment of objectives across
healthcare decision makers
3. Reflect views of the general public
– Reflecting tax-payers’/potential users’ view
15
16. Whose preferences for weighting the criteria?
1. Stakeholders as defined by the decision maker
– In line with extra-welfarist foundation of HTA
– Variations of stakeholders among diseases requires flexible
weights?
2. Members of an HTA committee
– Pragmatic approach which can avoid conducting large
preference-based studies
– Structure the deliberative process
3. Members of the general public
– Consistent with the approach taken to valuing QoL in QALYs
16
17. How to factor in cost and opportunity cost? (1)
• Separate criterion for cost (e.g. EVIDEM) or cost effectiveness
which contributes to the overall intervention value
– Need to avoid overlapping with other criteria
• All (incremental) benefits, combined by using an MCDA
aggregation approach (e.g. Israeli Health basket Committee in
Golan and Hansen, 2012), weigh against all (incremental)
costs
– Still need to identify the “hurdle for adoption”, e.g. cost per
incremental point score
– Redefine the cost effectiveness threshold?
17
18. How to factor in cost and opportunity cost? (2)
• Debate over the meaning and the measurement
methods of the cost effectiveness threshold
• Consideration of multiple attribute of values
(beyond health gains) can complicate estimation of
threshold
– Need for a “cost per performance score” reflecting benefits
forgone if the new technology is implemented
18
19. How can uncertainty be addressed?
• HTA bodies face high degree of uncertainty
– Evidence base of new interventions can be limited (particularly near their
launch)
• Acceptable level of uncertainty is a matter of judgment
– Currently, HTA bodies give large discretion to committees to decide on the
appropriate level of acceptability
Separate criterion for uncertainty
– Measuring and valuing it can be challenging
Use existing sensitivity analysis (SA) techniques
– It leaves open the question of how SA results should affect decisions
19
20. MCDA pilots and critical issues
Pilot/Critical
issue
Criteria and
weights
‘fixed’?
Whose criteria? Whose preferences
for weighting the
criteria?
How can the
opportunity cost of
new technologies
be incorporated?
How can
uncertainty be
addressed?
Israel Yes Current HTA/priority
setting’ criteria
(based on literature
review)
Convenience sample Value for money
chart (total net cost
vs net benefit) and
efficiency frontiers
Quality of
evidence shown
via different size
bubbles
Italy Yes Mix of EUnetHTA
Core Model and the
EVIDEM framework
Decision makers (i.e.
committee
members)
Economic and
Financial Impact
cluster including
‘cost effectiveness’
criterion
Not explained
Thailand Yes Current HTA bodies’
criteria in seven
countries
Equal weight
applied to all criteria
(in nomination of
intervention step)
Value for money
criterion (using cost
per QALY threshold)
Budget impact
criterion
Not explained
Germany No
(disease-
specific)
Outcome measures
relevant
to patients reported
in the literature
Patients Not considered Sensitivity
analysis
performed
20
21. Opportunities Challenges Unresolved HTA issues
Established HTA systems to
increase their accountability -
“show the quality and rigor of its
work to others” (Walker, 2016)
Balance between deliberation and
more structured approaches -
avoid asking committees “to
rubber-stamp” decisions (Walker,
2016)
How is the budget constraint
reflected in the process? What
does the threshold mean?
Countries developing new HTA
systems to avoid
issues/limitations of existing
systems
Benefits, in terms of improved
decision making, vs cost of
implementing any given approach
– would that minimise “wrong”
decisions?
Whose value to derive criteria and
weights remains a normative
question
Align objectives across NHS
decision makers
Reconciling divergent views of
multiple stakeholders
How to deal with uncertainty?
21
22. Conclusions
• It is difficult to make ‘hard’ conclusions about how MCDA should be
implemented in HTA given fundamental differences between health
care systems and HTA processes (‘one size does not fit all’)
• Consideration of cost and opportunity cost in a systematic way
remains a methodological challenge (not only from an MCDA
perspective)
• Use of MCDA in HTA has the potential to provide a
coherent/unifying framework for healthcare decision making
• Need to consider the balance between additional costs of
implementing an MCDA approach and additional benefits of
improved decision making process
• Even partial use of MCDA, e.g. performance matrix, may still
improve decision making processes
22
23. References (1)
• Danner, M., Hummel, J.M., Volz, F. et al. (2011). Integrating patients' views into health
technology assessment: Analytic hierarchy process (AHP) as a method to elicit patient
preferences. International Journal of Technology Assessment in Health Care. Oct;27(4):369-
75
• Devlin, N., and Sussex, J., (2011). Incorporating Multiple Criteria in HTA. Methods and
processes. OHE research https://www.ohe.org/publications/incorporating-multiple-criteria-
hta-methods-and-processes
• Garau, M., Devlin, N., (forthcoming). Using MCDA as a decision aid in Health Technology
Appraisal for coverage decisions: opportunities, challenges and unresolved questions. In
“MCDA in health care decision making” published by Springer
• Golan, O., Hansen, P., Kaplan, G., Tal, O., (2011). Health technology prioritization: which
criteria for prioritizing new technologies and what are their relative weights? Health Policy
Oct;102(2-3):126-35
• Golan,O., and Hansen, P., (2012). Which health technologies should be funded? A
prioritization framework based explicitly on value for money. Israel Journal of Health Policy
Research 1:44
23
24. References (2)
• Norheim O. F., Baltussen R., Johri M., et al., 2014. Guidance on priority setting in health care
(GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis. Cost
Effectiveness and Resource Allocation 12:18
• Radaelli, G., Lettieri, E., Masella, C., (2014). Implementation of EUnetHTA core Model® in
Lombardia: the VTS framework. International Journal of Technology Assessment in Health
Care 30:1; 105-12
• Thokala, P., Devlin, N., Marsh, K., et al. (2016) Multiple Criteria Decision Analysis for Health
Care Decision Making - An Introduction: Report 1 of the ISPOR MCDA Emerging Good
Practices Task Force. Value in Health Jan;19(1):1-13
• Walker, A., (2016). Challenges in using MCDA for reimbursement decisions on new
medicines? Value in Health 19: 123-124
• Youngkong, S., Baltussen, R., Tantivess, S., et al. (2012). Multicriteria decision analysis for
including health interventions in the Universal Health Coverage Benefit package in Thailand.
Value in Health 15; 961-970
24