Professor Nancy Devlin Director of Research ISPOR Philadelphia May 2015

Identifying best practice in MCDA: some issues for discussion

Introduction to OHE

March 2015 2

1. Should the criteria and weights used in MCDA by a given decision maker be the same for each decision, or chosen on a case-by-case basis?

• ‘Best practice’ might depend on what type of health care decision MCDA is being applied to.

• e.g. benefit risk assessment: no budget constraint; relevant risks and benefits differ between each case.

• e.g. HTA; budget holder prioritisation frameworks: entail repeated decisions aiming to achieve efficiency from a limited budget. Consistency is key?

Introduction to OHE

March 2015 3

2. What should best practice guidelines say about whose weights are relevant?

• Essentially a normative question.

• Answer clear for some decision types:

• Shared Decision Making: weights should reflect the patient’s preferences.

• Portfolio Optimisation: weights reflect the maximand of the decision maker (e.g profit)

• More complex for HTA, BRA, budget allocation: Patients? Committee members? The general public? What should we be recommending about this? Or should we remain agnostic?

Introduction to OHE

March 2015 4

3. Does best practice entail MCDA be used for all decisions – or more selectively, e.g. only for ‘complex’ decisions.

• If consistency of decisions is key, consistent application of MCDA suggested

• Selective use of MCDA reduces costs – but how to select/recommend when it should be used? (eg. what is a ‘complex’ decision?)

Introduction to OHE

March 2015 5

4. How should organisational resource constraints be reflected in our guidance on best practise in MCDA?

• Not helpful to identify ‘best practice’ guidelines in terms of ‘best’ technical approaches which, in practice, impose too great a burden (time, money) to implement.

• Best practice needs to be ‘fit for purpose’

• Should we also be identifying ‘second best practice’? eg. is partial use of MCDA, to generate a performance matrix for options, better than nothing at all?