Multicriteria decision analysis to support health technology assessment agencies: benefits, limitations, and the way forward

Rob Baltussen, Kevin Marsh, Praveen Thokala, Vakaramoko Diaby, Hector Castro, Irina Cleemput, Martina Garau, Georgi Iskrov, Alireza Olyaeemanesh, Andrew Mirelman, Mohammedreza Mobinizadeh, Alec Morton, Michele Tringali, Janine van Til, Joice Valentim, Monika Wagner, Sitaporn Youngkong, Vladimir Zah, Agnes Toll, Maarten JansenLeon Bijlmakers, Wija Oortwijn, Henk Broekhuizen

Research output: Contribution to journalArticlepeer-review

30 Citations (Scopus)
23 Downloads (Pure)


Recent years have witnessed anincreased interest in the use of multi-criteria decision analysis (MCDA) to support health technology assessment (HTA) agencies for setting health care priorities. However, its implementation to date has been criticised for being "entirely mechanistic", ignoring opportunity costs and not following best practice guidelines. This paper provides guidance on the use of MCDA in this context.
Study design
Consensus development; Systematic review
Methods We developed a typology of MCDA studies and good implementation practice. We reviewed 37 studies over the period 1990-2018 on their compliance with good practice, and developed recommendations. We reached consensus among authors over the course of several review rounds.
We identified three MCDA study types: qualitative MCDA, quantitative MCDA and MCDA with decision rules. The types perform differently in terms of quality, consistency, and transparency of recommendations on health care priorities. We advise HTA agencies to always include a deliberative component. Agencies should, at a minimum, undertake qualitative MCDA. The use of quantitative MCDA has additional benefits but also poses design challenges. MCDA with decision rules, used by HTA agencies in the Netherlands and the UK and typically referred to as structured deliberation, has the potential to further improve the formulationof recommendations but has not yet been subjected to broad experimentation and evaluation.
Original languageEnglish
Pages (from-to)1283-1288
Number of pages6
JournalValue in Health
Issue number11
Early online date16 Oct 2019
Publication statusPublished - 30 Nov 2019


  • multi criteria decision analysis
  • priority setting
  • value framework
  • HTA agencies


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