Advancing MCDA and HTA into coverage decision-making

Abstract

Introduction: Country- and region-specific health technology assessment (HTA) organisations for priority-setting and resource allocation have emerged around the world. Decision-making in healthcare is a continuum from evidence generation to deliberation and communication of the decision made, and HTA is only a part of this process whereby the available evidence is assessed to inform decision-makers about the most efficient use of resources. Besides the assessment, reimbursement decision-making also involves appraising the available evidence, while bearing in mind societal values and ethical considerations. Even in countries where formal HTA activities are ongoing, transparency levels of resource-allocation decisions vary reflecting competing interests of governments and other stakeholders. Overview: While multiple publications have examined the role of HTA through the collection of data, there is still limited knowledge of how decision-makers use and value this evidence, as well as the challenge of incorporating other broader criteria in an explicit manner. Multi-criteria decision analysis (MCDA) has emerged as a tool to support decision-making in healthcare. MCDA supports decision-making by breaking down complex problems into multiple components and drawing on both qualitative and quantitative approaches to measure and then combine these components. Objectives: The aim of this chapter is to demonstrate the potential of, as well as the challenges associated with, using MCDA for resource-allocation decisions by presenting case studies carried out by well-established institutions in Colombia, the region of Lombardy in Italy and Belgium. Conclusion: Further research on merging MCDA and HTA to support better informed coverage decision-making, especially on methods, consistency and replicability of MCDA results may be of value for all countries.