What a health care system should pay for depends, of course, on the health gain that results. Health technology assessment (HTA) and cost-effectiveness analysis have become the core for many such decisions, by NICE in the UK and by similar bodies elsewhere. Other factors, however, also are taken into account by the governments and insurers who fund health care. These typically include: the impact of decisions on social equity; the quality of the patient experience; ramifications for the wider economy; and the quality of evidence required for decision making. The purpose of this OHE monograph is to inform and stimulate debate about the way different sorts of evidence and considerations are taken into account in decisions about new health care technologies.
Awareness of the importance of incorporating a number of considerations into decisions about resource allocation in health care and many other fields has given rise to ‘multiple criteria decision analysis’ (MCDA). This is defined by the authors of this monograph as ‘A set of methods and approaches to aid decision-making, where decisions are based on more than one criterion, which make explicit the impact on the decision of all the criteria applied and the relative importance attached to them’. The monograph is an invaluable primer on MCDA, explaining what MCDA is and how it can be used in health care. It includes examples of the use of this approach in the UK by local NHS organizations, in areas of the public sector other than health, and in health system decision-making in other countries. Both the advantages of using MCDA and its costs and risks are identified.
The authors argue for greater use of MCDA as an aid to decision-making that is based on HTA, both in the NHS and in other countries. MCDA encourages a valuable discipline in requiring the explicit identification and weighting of the criteria that are used to make health care resource allocation decisions. This approach also increases transparency, making it easier to hold decision makers accountable for the choices they make on behalf of the public; this should lead to greater public confidence in the decisions that result, according to the authors.
The report will be of value to anyone interested or involved in the policy and practice of health technology appraisal – and, more generally, to anyone involved in resource allocation in health care.