Multi-criteria decision analysis (MCDA)

Multi-criteria decision analysis (MCDA) is a domain of operational research used in healthcare decision making. The technique recognises that decision makers use multiple and disparate criteria when making decisions (e.g. about introducing new healthcare interventions or facilities) and that it is important to make explicit the impact of all the criteria applied on any decision and the relative importance attached to them. In MCDA, criteria affecting a decision are identified and weighted using explicit, transparent techniques. Different options (strategies, interventions etc.) are then scored against each criterion and the weights are used to provide summary scores for comparative purposes. MCDA is attractive in health technology assessment, especially in healthcare systems where there is reluctance to primarily use a single decision metric (such as the incremental cost-effectiveness ratio). It helps to make the assumptions underpinning decisions more transparent, which (in principle) may improve accountability and consistency of decision making. While its uptake in healthcare has been slow due to technical challenges in defining criteria and assigning weights, it is finding new applications, such as within risk-benefit analysis.