‘Multiple criteria decision analysis’ is a crummy name for a great concept (aren’t all big decisions analyzed using multiple criteria?). MCDA means assessing alternatives while simultaneously considering several objectives. It’s a useful way to look at difficult healthcare choices. But oftentimes, results of these analyses aren’t communicated clearly, limiting their usefulness.
ISPOR, the International Society For Pharmacoeconomics and Outcomes Research, has developed new MCDA guidance, available in the latest issue of Value for Health (paywall). To be sure, healthcare decision makers have always weighed medical, social, and economic factors: MCDA helps stakeholders bring concrete choices and transparency to the process of evaluating outcomes research – where as we know, controversy is always a possibility.
Anyone can use MCDA. To put it mildly, it’s difficult to balance saving lives with saving money. Fundamentally, MCDA means listing options, defining decision criteria, weighting those criteria, and then scoring each option. Some experts build complex economic models, but anyone can apply this decision technique in effective, less rigorous ways.
You know those checklists at the end of every HouseHunters episode where people weigh location and size against budget? That’s essentially it: Making important decisions, applying judgment, and balancing multiple goals (raise the kids in the city or the burbs?) – and even though they start out by ranking priorities, once buyers see their actual options, deciding on a house becomes substantially more complex.
MCDA gains traction in health economics. As shown in the diagram (source: ISPOR), the analysis hinges on assigning relative weights to individual decision criteria. While this brings rationality and transparency to complex decisions, it also invites passionate discussions. Some might expect these techniques to remove human judgment from the process, but MCDA leaves it front and center.
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Pros and cons. Let’s not kid ourselves: You have to optimize on something. MCDA is both beautiful and terrifying because it forces us to identify tradeoffs: Quality, quick improvement, long-term health benefits? Uncertain outcomes only complicate things further. One of the downsides is that, upon seeing elaborate projections and models, people can become over-confident in the numbers. Uncertainty is never fully recognized or quantified. (Recall the Rumsfeldian unknown unknown.) Sensitivity analysis is essential, to illustrate which predicted outcomes are strongly influenced by small adjustments.
Communicating the results. MCDA is a great way to bring interdisciplinary groups into a conversation. But because it is so complex, it’s essential that the analysis be communicated effectively, so stakeholders understand the choices being made. At a minimum, this should include straightforward charts or tables identifying the decision criteria, showing how they’re weighted, and summarizing analytical results – bringing us back to the HouseHunters Wish List/Checklist. (If you’re new to HEOR writing, don’t miss this fantastic lineup of medical writers and HEOR experts.)
Resources to learn more. If you want to try MCDA, pick up one of the classic texts, such as Smart Choices: A Practical Guide to Making Better Decisions. The ISPOR report is Multiple Criteria Decision Analysis for Health Care Decision Making – An Introduction: Report 1 of the ISPOR MCDA Emerging Good Practices Task Force by Thokala et al. Additionally, ISPOR’s members offer useful insights into the pluses and minuses of this methodology – see, for example, Does the Future Belong to MCDA? The level of discourse over this guidance illustrates how challenging healthcare decisions have become.