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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

46 Citations (Scopus)
37 Downloads (Pure)


Objective: Recent years have witnessed an increased interest in the use of multicriteria decision analysis (MCDA) to support health technology assessment (HTA) agencies for setting healthcare priorities. However, its implementation to date has been criticized for being “entirely mechanistic,” ignoring opportunity costs, and not following best practice guidelines. This article provides guidance on the use of MCDA in this context. Methods: The present study was based on a systematic review and consensus development. We developed a typology of MCDA studies and good implementation practice. We reviewed 36 studies over the period 1990 to 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 3 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 healthcare 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 United Kingdom and typically referred to as structured deliberation, has the potential to further improve the formulation of recommendations but has not yet been subjected to broad experimentation and evaluation. Conclusion: MCDA holds large potential to support HTA agencies in setting healthcare priorities, but its implementation needs to be improved.

Original languageEnglish
Pages (from-to)1283-1288
Number of pages6
JournalValue in health
Issue number11
Early online date16 Oct 2019
Publication statusPublished - 1 Nov 2019


  • HTA agencies
  • multicriteria decision analysis
  • priority setting
  • value framework


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