Using decision analysis to select alternate modes of dispensing: An example from Los Angeles County Public Health

Abstract

Objective: To comply with the Center for Disease Control’s mass prophylaxis mandates, many public health jurisdictions must supplement their existing Points of Dispensing (POD)-based system. Because of limited budgets and personnel availability, only one or two alternatives out of the many potential options can be implemented.Design: Multicriteria decision analysis is a powerful tool that allows public health officials to assess the relative effectiveness of alternate modes of dispensing while incorporating the opinions of their multidisciplinary emergency response planning teams.Setting: This process was utilized to analyze the effectiveness of alternate modes of dispensing that could be used to supplement the existing POD system within the Los Angeles County (LAC) Department of Public Health (DPH).Results: The top two options for LAC were prepositioning for civil service and partnership with a major Health Maintenance Organization. These choices were stable under a variety of sensitivity analyses, and the differences in opinion between the agencies and other stakeholders do not change them.Conclusions: The transparency of the model and analysis may allow decision makers and planners in the LAC DPH to garner support for their alternate modes of dispensing plans. By making the decision criteria clear and demonstrating the robustness of the results in the sensitivity analyses, public health partners gain a deeper understanding of the issues and their potential roles. The process can be repeated by any jurisdiction, but definition of “best” will rely on the issues and gaps that are identified with the jurisdiction’s POD plan for mass prophylaxis.