Multi-criteria decision analysis to support HTA agencies – benefits, limitations and the way forward

Objective 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. Results 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.