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[:pb]It is known that decision-making processes on the incorporation of healthcare technologies involve several actors and variables, which makes them extremely complex. The methodology of Healthcare Technology Assessments (HTA) has been used in several countries, including Brazil, where it is mandatory for technologies to be incorporated by the Unified Health System (SUS).

Health economics studies and analyzes based on real-world evidence, which are part of the so-called HEOR (Health Economics & Outcomes Research) play the role of evaluating the costs against the results provided by the technologies. However, the incorporation of new technologies also encompasses factors other than costs and clinical outcomes. There are also social, organizational, ethical and legal dimensions that must be considered. For this task, there are the Multicriteria Decision Analysis (MCDA – Multiple criteria decision analysis).

What is Multi-Criteria Decision Analysis?

Multi-criteria decision analysis consists of a set of methods to jointly assess two or more criteria. This methodology does not replace systematic reviews, economic evaluations or other types of analysis used in decision making, but adds to this entire process, as it is able to gather available evidence and perceptions of different actors.

It is suitable for issues involving interdependent decisions or the participation of professionals from different areas, and is especially important when there is more than one point of view about a decision. The MCDA allows you to build a “performance matrix”, capable of supporting discussions in the process of analyzing technologies that involve different groups.

Among the criteria that can be evaluated according to this methodology are unsatisfied medical needs, the social burden of the disease and issues specific to family members and health professionals.

Advantages of the MCDA Model

Multi-criteria decision analysis seeks to consider all priorities in a balanced way, in addition to enabling the participation of different stakeholders, from patients and family members to physicians and health managers. Objectively, this methodological approach allows the criteria to be defined in order of relevance and determines how best to use this information to assess the alternatives in question. This makes the model have advantages such as:

  • Greater consistency and transparency, since the criteria that influenced the decision are clearly stated and it is easier to follow and visualize each step;
  • Easier to assign responsibilities and discuss the perspectives of different interest groups;
  • Better understanding by stakeholders of decisions, including the contribution of each criterion to the outcome and understanding of recommendations.

How and when can it be used?

Multi-criteria decision analysis is not exclusive to healthcare, but is also used in decision-making in sectors such as sustainable energy, transport and energy planning, among others. To support the health area, the method has been applied in some situations, namely:

  • Risk-benefit assessment of health interventions;
  • In HTAs, by simultaneously evaluating multiple criteria to support the decision on resource allocation;
  • Standardization of prioritization by context, supporting managers in the preparation of investment plans, for example, healthcare plans and hospitals;
  • In portfolio decision analysis (ADP), to assess the probability of success of different projects;
  • In shared decision-making (TDC), which involves patients, doctors and other health professionals;
  • In defining the priority of patient access to health services;
  • Methodology can play an important role, for example, when it comes to rare diseases, since in these cases the technologies are often costly and the prevalence of the disease low. On the other hand, the burden for the patient and family is often high, which would justify an analysis involving all these criteria;
  • In the evaluation of medical care equipment, when it is important to go beyond the analysis of aspects such as effectiveness, safety and cost, also evaluating factors such as operability, usability, innovation, maintenance, learning curve, among other criteria.

Steps of Multi-Criteria Decision Analysis

There are a few different methods for performing an MCDA, so the steps in the process may vary slightly. However, in general, it must follow some fundamental phases:

  • Define the problem;
  • Select and structure the criteria to be evaluated;
  • Measure performance;
  • Assign scores to alternatives;
  • Assign weights to each criterion;
  • Calculate the aggregated scores, according to the scores and weights assigned to each criterion;
  • Dealing with uncertainty, as both the criteria chosen, the performance measures and the points of view used are subject to some uncertainty;
  • Interpret and report results.

To learn more about our solutions for incorporating healthcare technologies, download the MAPES e-book:MAPES: Cases &Soluções.[:]

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