Multi-Criteria Decision Analysis (MCDA) as the basis for thedevelopment, implementation and evaluation of interactive patientdecision aids

BackgroundSince decision making about treatment with disease-modifying drugs (DMDs) for multiple sclerosis (MS) is preference sensitive, shared decision making between patient and healthcare professional should take place. Patient decision aids could support this shared decision making process by providing information about the disease and the treatment options, to elicit the patient’s preference and to support patients and healthcare professionals in discussing these preferences and matching them with a treatment. Therefore, a prototype of a patient decision aid for MS patients in the Netherlands—based on the principles of multi-criteria decision analysis (MCDA) —was developed, following the recommendations of the International Patient Decision Aid Standards. MCDA was chosen as it might reduce cognitive burden of considering treatment options and matching patient preferences with the treatment options.ResultsAfter determining the scope to include DMDs labelled for relapsing-remitting MS and clinically isolated syndrome, users’ informational needs were assessed using focus groups (N = 19 patients) and best-worst scaling surveys with patients (N = 185), neurologists and nurses (N = 60) to determine which information about DMDs should be included in the patient decision aid. Next, an online format and computer-based delivery of the patient decision aid was chosen to enable embedding of MCDA. A literature review was conducting to collect evidence on the effectiveness and burden of use of the DMDs. A prototype was developed next, and alpha testing to evaluate its comprehensibility and usability with in total thirteen patients and four healthcare professionals identified several issues regarding content and framing, methods for weighting importance of criteria in the MCDA structure, and the presentation of the conclusions of the patient decision aid ranking the treatment options according to the patient’s preferences. Adaptations were made accordingly, but verification of the rankings provided, validation of the patient decision aid, evaluation of the feasibility of implementation and assessing its value for supporting shared decision making should be addressed in further development of the patient decision aid.ConclusionThis paper aimed to provide more transparency regarding the developmental process of an MCDA-based patient decision aid for treatment decisions for MS and the challenges faced during this process. Issues identified in the prototype were resolved as much as possible, though some issues remain. Further development is needed to overcome these issues before beta pilot testing with patients and healthcare professionals at the point of clinical decision-making can take place to ultimately enable making conclusions about the value of the MCDA-based patient decision aid for MS patients, healthcare professionals and the quality of care.

Modeling multi-criteria decision analysis in residential PV adoption

Background: Multi-criteria decision analysis (MCDA) is a decision-making tool that can take into account multidimensional factors and enables comparison of (medical) technologies by combining individual criteria into one overall appraisal. The MCDA approach has slowly gained traction within Health Technology Assessment (HTA) and its elements are gradually being incorporated into HTA across Europe. Several groups of scientists have proposed MCDA approaches targeted toward orphan drugs and rare diseases by including criteria specific to rare diseases. The goal of this article is to provide an overview of the current state of knowledge and latest developments in the field of MCDA in HTA for orphan drugs, to review existing models, their design characteristics, as well as to identify opportunities for further model improvement.Methods: A systematic literature search was conducted in January 2018 using four databases: MEDLINE (Pubmed), EBSCO HOST, EMBASE, and Web of science to find publications related to use of MCDA in the rare disease field (keywords: MCDA/orphan drug/rare disease and synonyms). Identified MCDA models were analyzed, e.g., structure, criteria, scoring, and weighting methodology.Results: Two hundred and eleven publications were identified, of which 29 were included after removal of duplicates. 9 authors developed own MCDA models, 7 of which based on literature reviews intended to identify the most important and relevant decision criteria in the model. In 13 publications (8 models) weights were assigned to criteria based on stakeholder input. The most commonly chosen criteria for creation of the MCDA models were: comparative effectiveness/efficacy, the need for intervention, and disease severity. Some models have overlapping criteria, especially in the treatment cost and effectiveness areas.Conclusions: A range of MCDA models for HTA have been developed, each with a slightly different approach, focus, and complexity, including several that specifically target rare diseases and orphan drug appraisal. Models have slowly progressed over the years based on pilots, stakeholder input, sharing experiences and scientific publications. However, full consensus on model structure, criteria selection and weighting is still lacking. A simplification of the MCDA model approach may increase its acceptance. A multi-stakeholder discussion on fundamental design and implementation strategies for MCDA models would be beneficial to this end.

The mismatch between the health needs of populations affected by emergencies and resources devoted to response is projected to further increase. Making the response more effective is one of the solutions to meet the growing needs. Multi-criteria decision analysis (MCDA) has been successfully used to increase effectiveness in various fields by supporting decision-making. However, no review of its application to all-hazard health emergencies has been done to date. A review of peer-reviewed English-language articles published since 2004 was conducted in May 2024 using Scopus, PubMed and Web of Science databases. The review focused on the empirical application of MCDA to support decision-making during health emergencies. The review was guided by the Joanna Briggs Institute methodology for scoping reviews and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Quantitative data were analyzed using summary statistics and qualitative data were analyzed using content analysis. Seventy-one articles were included after screening. The articles described the MCDA application to support a variety of decision problems related to health emergency management. However, the technique was mostly applied to infectious hazards management and only seldom to other hazards. The review also found a lack of standardized methodology for identifying alternatives and criteria, weighting, computation of model output, methods of dealing with uncertainty, and stakeholder engagement. The review provides an overview of the current use of the MCDA approach to support decision-making in health emergency management and informs areas of future development. The review emphasizes that while MCDA is already used for infectious hazards, it is underutilized for other types of health emergencies. Developing tailored MCDA approaches for health emergencies, including defining evaluation criteria and stakeholder engagement, may improve uptake of the technique and benefit the efforts to meet the growing health needs of the population affected by emergencies, https://osf.io/6kd5s/.

Smoking is the single biggest cause of preventable death in the Uited Kingdom (UK) and is a major cause of coronary heart disease, some cancers, and respiratory disease, including chronic obstructive pulmonary disease. At the time of initiating the project, smoking prevalence had not changed across four local government areas in South Yorkshire for some years. Most spending had been focussed on helping people quit, an intervention where there was clear evidence of effectiveness. A number of changes occurred in public health structures and targets, requiring a reappraisal of the range of interventions offered. This was challenging due to a lack of clear evidence for some of the areas’ alternative interventions. The aim of this paper is to describe the use of a multi-criteria decision analysis (MCDA) approach to support the health priority setting in local authorities to reduce smoking prevalence. There were three phases to this process: (1) problem structuring; (2) the multiple criteria decision analysis; (3) and using the MCDA results to influence decision making at the local government level. The MCDA approach was used to collate information in a consistent and transparent manner, using expert, stakeholder and public opinion to fill known gaps in evidence. Fifteen interventions (such as stop smoking support services, smoke-free spaces, communication and marketing exercises, and increased investment in enforcement) were ranked across eight criteria (relating to reductions in prevalence across relevant groups, as well as aspects relating to equity and feasibility), allowing a range of relevant concerns to be incorporated. Subsequent steps were taken to translate the results of this stage into workable policy options. The results differed significantly from current practice. Sensitivity analysis showed that the findings were robust to changes in preference weights. These results informed subsequent changes to the interventions offered across the four boroughs. The ability of MCDA techniques to incorporate data and both qualitative and quantitative judgements in a formal manner mean that they are well suited to support public health decision making, where evidence is often only partially available and many policies are value driven. MCDA methods, if used, should be chosen carefully based on their resource/time constraints, scientific validity, and the significance and broader context of the decision problem.

Introduction:The use of multi-criteria decision analysis (MCDA) in health technology assessment (HTA) studies has become more common due to the fact that MCDA offers a comprehensive technique for decisions that involve multiple criteria and stakeholders. How MCDA contributes to the HTA decision making process is an issue to be investigated. A systematic review was carried out in order to provide an overview of the benefits identified in MCDA applications for the strategic HTA decision making process.Methods:A systematic review developed by Philip Wahlster et al. (2014) was updated. The papers were analyzed in order to determine how MCDA is connected with traditional HTA, and to identify opportunities through the application of MCDA. In total 965 papers were found, and 43 articles were included in the review. The included articles detailed MCDA applications oriented to tactical and strategic decision making processes. The review was conducted by two researchers.Results:Of the available studies published on MCDA, 76 percent were published between 2014 and 2017, and 24 percent were published prior to 2014. Regarding the MCDA methodology defined in the included studies, 10 used the analytical hierarchy process, four used multi-attribute theory, and others refer the methodology only as “MCDA”. Seventeen studies also included health technology economic analysis, in special cost-effectiveness, safety and technological innovation. The studies suggest MCDA adds value since it allows different stakeholders to be engaged in the decision making process.Conclusions:The increase in studies on MCDA and healthcare point to the possibility to add different criteria, engage people with different knowledge levels, and make the decision-making process more transparent. In comparison with other technical areas, the use of MCDA in healthcare is more focused on achieving the decision about adding the new technology, and to show how to engage stakeholders than to explain how to develop the algorithms and methodologies.

<p>THEORETICAL FOUNDATIONS AND USE OF MULTI-CRITERIA DECISION ANALYSIS IN THE PHARMACEUTICAL SECTOR OF UKRAINE ACCORDING TO THE EUROPEAN REFORMING VECTOR</p><p>O.B. Piniazhko, O.M. Zaliska</p><p>Danylo Halytsky Lviv National Medical University</p><p> </p><p>The reforming of health care system has been started to carry out in Ukraine. Assessing the value of medical technologies may require new approaches that take into account a more comprehensive set of parameters than the incremental cost-effectiveness ratio, ICER/ quality adjusted life years, QALY.</p><p>Technological advancements in combination with higher life expectancy, higher patient expectations, and increased prevalence of chronic diseases, have led to significant increases in public spending on pharmaceuticals, which, on average account for 9,3% of total health expenditure or about 1,4% of GDP across OECD countries (OECD, 2012). Given the resources governments and health systems can spend on healthcare, the pathway to optimal resource allocation passes through cost containment and efficiency improvement policies. </p><p>In the context of multi-criteria decision analysis (MCDA), elements of value can be measured and scored in their natural units or through constructed scales, quantitatively or qualitatively, and weights are assigned to reflect criteria’s importance when combining them. This approach may provide a more comprehensive account of value parameters, greater transparency in how multiple criteria are explicitly valued, weighted, and aggregated, and a more inclusive approach to stakeholder views on value.</p><p>Our aim was to perform a comparative analysis of the main approaches, methods and stages of MCDA, to determine the urgent and relevant use of MCDA in health care system of Ukraine based on the experience of developed countries.</p><p>We have analyzed the ukrainian and foreign publications, articles, systematic reviews, practical guidelines on MCDA in health care using PubMed, EMBASE, Internet resources as search tools.</p><p>Decision analysis can provide an alternative way of measuring and eliciting value. In particular, MCDA is both an approach and a set of techniques, with the goal of providing an overall ordering of options by looking at the extent to which a set of objectives are achieved. MCDA methodologies have been suggested for use in public services since 1960. MCDA has been used, on an experimental basis, in order to assess the benefit-risk (clinical) profile of new medicines for the purpose of regulatory approval during marketing authorisation stage by the European Medicines Agency and others. Its use has also been suggested in health care and value assessment in HTA also offering a conceptual framework.</p><p>Although a variety of MCDA methodologies exist, the process of MCDA includes a number of common stages as follows: 1) establishing the decision context by defining the aims of the MDCA, and who the decision makers and other key stakeholders are; 2) identifying the objectives and criteria that reflect the value associated with the consequences of each option; 3) «scoring» the value associated with the performance of each option against the criteria; 4) «weighting» each of the criteria to reflect their relative importance to the decision; 5) examine the results; 6) conducting a sensitivity analysis of the results to test the influence of changes in scores or weights.</p><p>As the results of our review we suggested the urgent and relevant use of MCDA in health care system of Ukraine based on the experience of developed countries. The comparative analysis of the main approaches, methods and stages of MCDA was performed and trends of it’s implementation in the pharmaceutical industry of our country were suggested.</p><p>Due to the performed analysis, in our opinion in order to optimize and improve the decision-making process in health care the implementation of MCDA approach will provide transparent and consistent management decisions in Ukraine.</p>

The evaluation of soil erosion is often assessed using traditional soil-loss models such as the Revised Universal Soil-Loss Equation (RUSLE) and the Soil and Water Assessment Tool (SWAT). These models provide quantitative outputs for sediment yield and are often integrated with geographic information systems (GIS). The work described here is focused on transitioning towards a qualitative assessment of erosion potential using Multi-Criteria Decision Analysis (MCDA), for improved decision-support and watershed-management prioritization in a northern Gulf of Mexico coastal watershed. The foundation of this work conceptually defined watershed erosion potential based on terrain slope, geomorphology, land cover, and soil erodibility (as defined by the soil K-factor) with precipitation as a driver. These criteria were evaluated using a weighted linear combination (WLC) model to map generalized erosion potential. The sensitivity of individual criteria was accessed with the one-at-a-time (OAT) method, which simply removed one criterion and re-evaluated erosion potential. The soil erodibility and slope were found to have the most influence on erosion-potential modeling. Expert input was added through MCDA using the Analytical Hierarchy Process (AHP). The AHP allows for experts to rank criteria, providing a quantitative metric (weight) for the qualitative data. The individual AHP weights were altered in one-percent increments to help identify areas of alignment or commonality in erosion potential across the drainage basin. These areas were used to identify outliers and to develop an analysis mask for watershed management area prioritization. A comparison of the WLC, AHP, ensembled model (average of WLC and AHP models), and SWAT output data resulted in visual geographic alignment between the WLC and AHP erosion-potential output with the SWAT sediment-yield output. These observations yielded similar results between the qualitative and quantitative erosion-potential assessment approaches, with alignment in the upper and lower ranks of the mapped erosion potentials and sediment yields. The MCDA, using the AHP and ensembled modeling for mapping watershed potential, provided the advantage of more quickly mapping erosion potential in coastal watersheds for improved management of the environmental resources linked to erosion.

Qualitative methods tend to be used to incorporate patient preferences into healthcare decision making. However, for patient preferences to be given adequate consideration by decision makers they need to be quantified. Multi-criteria decision analysis (MCDA) is one way to quantify and capture the patient voice. The objective of this review was to report on existing MCDAs involving patients to support the future use of MCDA to capture the patient voice. MEDLINE and EMBASE were searched in June 2014 for English-language papers with no date restriction. The following search terms were used: 'multi-criteria decision*', 'multiple criteria decision*', 'MCDA', 'benefit risk assessment*', 'risk benefit assessment*', 'multicriteri* decision*', 'MCDM', 'multi-criteri* decision*'. Abstracts were included if they reported the application of MCDA to assess healthcare interventions where patients were the source of weights. Abstracts were excluded if they did not apply MCDA, such as discussions of how MCDA could be used; or did not evaluate healthcare interventions, such as MCDAs to assess the level of health need in a locality. Data were extracted on weighting method, variation in patient and expert preferences, and discussion on different weighting techniques. The review identified ten English-language studies that reported an MCDA to assess healthcare interventions and involved patients as a source of weights. These studies reported 12 applications of MCDA. Different methods of preference elicitation were employed: direct weighting in workshops; discrete choice experiment surveys; and the analytical hierarchy process using both workshops and surveys. There was significant heterogeneity in patient responses and differences between patients, who put greater weight on disease characteristics and treatment convenience, and experts, who put more weight on efficacy. The studies highlighted cognitive challenges associated with some weighting methods, though patients' views on their ability to undertake weighting tasks was positive. This review identified several recent examples of MCDA used to elicit patient preferences, which support the feasibility of using MCDA to capture the patient voice. Challenges identified included, how best to reflect the heterogeneity of patient preferences in decision making and how to manage the cognitive burden associated with some MCDA tasks.

OA16.02 Shared Decision Making (SDM) and Patient Decision Aids (PDAs) in Lung Cancer: Survey of Patients, Significant Others or Caregivers

Commentary: Postrecurrence survival in patients with lung cancer after curative surgery warrants systematic investigation to optimize management strategies

Multicriteria Decision Analysis to Support Health Technology Assessment Agencies: Benefits, Limitations, and the Way Forward

Groundwater is a vital resource, particularly in arid and semi-arid regions where surface water availability is limited. This study focuses on mapping groundwater potential zones (GWPZs) in the Dhule district of Maharashtra, India, an area characterized by complex hydrogeological conditions within the Deccan Volcanic Province (DVP). Utilizing a multi-criteria decision analysis (MCDA) approach, the study integrates geospatial techniques with geoelectric data to accurately delineate areas with high groundwater potential. The analytical hierarchy process (AHP) combined with Geographic Information System (GIS) methodologies enables a detailed assessment of various influencing factors, including geological structures, soil texture, slope, drainage density, and land use patterns. Key findings highlight that regions with specific geological formations, such as weathered and fractured basalts and areas with dykes, show higher groundwater potential due to their enhanced porosity and permeability. The study identifies the central Shindkheda, southern Sakri, and Dhule subdivisions as critical areas for implementing groundwater recharge techniques to mitigate surface runoff and erosion. Recommendations for these regions include the construction of trenches, bunds, recharge pits, and percolation tanks. Additionally, the adoption of water-saving technologies such as drip irrigation and rainwater harvesting is emphasized to improve groundwater recharge and management. The validated approach establishes a strong foundation for future research and interventions aimed at enhancing water security in similar hydrogeological settings. The integration of AHP and GIS provides a robust framework for groundwater resource management, offering valuable insights for decision-makers focused on sustainable water resource utilization.

Assessment of priorities in critical material recovery from Waste Electrical and Electronic Equipment

Quality Drinking water needs to be maintained for the healthy human body. This study focuses on delineating and expressing the water quality level concerning Water Quality Index, which involves implementing Multi-Criteria Decision Analysis techniques such as Analytical Hierarchy Process and Analytic Network Process. For this purpose, surface water samples are accumulated from Jirania, Tripura, and the quality of the intake tap water, and the treated purified water is compared for each of the sampling stations. The study’s objective is to determine a new process from evaluating the water quality index with the Multi-Criteria Decision Analysis approach. The present investigation approximates the Water Quality Index with Analytical Hierarchy Process. It will also validate the same by comparing it with the Analytic Network Process incorporating the novel criteria like Cost, Potability, and Taste. Dissolved Oxygen has emerged as the most influential parameter in determining water quality. Sensitivity analysis is also performed to validate the Multi-Criteria Decision Analysis approach in index evaluation. The present study uses a comparative approach in assigning weighted values to the water quality parameters in which the priorities given to the various criteria in the Multi-Criteria Decision Analysis processes might not be consistent for all sections of users, and as a result of which the weighted value might show slight changes during computation of Water Quality Index for different water samples across the world. The accuracy of the Water Quality Index evaluation shall improve if a fixed set of criteria and their preference are maintained and justified based on which the water quality parameters are ranked, and their relative weights will be assessed accordingly.