Multiple criteria decision analyisis for health technology assessment: scientific substantiation of criteria selection in Ukraine

Abstract

Multiple-criteria decision analysis (MCDA) is a framework where multiple criteria are being considered in a well-structured manner during the decision-making process. This methodology is becoming increasingly popular for aiding and supporting health-care decision making. Defining the criteria is a critical stage in the process as it forms the foundation of MCDA.
 Our aim was to review information sources on the application of MCDA in practice in the world and to analyze the criteria included in the MCDA models. Research objects were MCDA reports and models from PubMed database. Research methods were system and content analyzes, data synthesis, generalization, extrapolation, statistical.
 We reviewed scientific publications and official documents of existing or proposed MCDA models. We identified the criteria and assigned them into nine groups: Economics, Disease description, Intervention description, Health gain, Feasibility, Prevalence, Evidence quality, Social and ethical factors and Other criteria. We looked at MCDAs which are aimed to be used for Reimbursement or Investment Decisions (86%) and for Authorization Decisions (14%). Of the reviewed 25 MCDA models aimed to support reimbursement decisions only 1 lacks cost-related criteria, while 7 scoring systems lack social and ethical factors and 12 MCDAs don’t mention epidemiology or classification of target groups directly. We found that none of the reviewed MCDAs used for authorization decisions mentioned socioeconomic criteria. There is no direct connection between the number of criteria included in MCDA models intended to support reimbursement decisions and the GDP per capita figures of countries.
 It can be seen that the selection of criteria has no standardized approach yet and most of the existing or proposed MCDA models were conducted to be relevant for decision-makers in the particular decision problems. The MCDAs supporting reimbursement decisions considered more criteria and the majority of them included economics and societal factors while most MCDAs intended to support authorization decisions only focused on the potential health benefits and outcomes. The most MCDA models included in our research were built in high-income countries.