What is MCDA and why do we need it?

Value measurement using cost-effectiveness analysis (CEA) is one of the core stables of health economic research.  CEA often uses quality adjusted life years (QALYs) to capture how a treatment affects a patients mortality and morbidity.  CEA makes explicit assumptions about the tradeoffs between mortality and morbidity by assuming these are additive.  Further, this approach, however, ignores much that may be important to patients including mode of administration, caregiver burden, risk preferences, and other factors. 

A 2019 paper by Charles Phelps and Guruprasad Madhavan argues that a better approach may be to incorporate the use of multi-criteria decision analysis (MCDA).  This approach—developed from systems engineering—measures how different treatments perform across a variety of attributes and explicitly asks the decision maker to weigh these different decisions.  I helped to create MCDA modules for the Innovation and Value Initiative’s IVI-RA and IVI-NSCLC Value Tools.  There are a variety of different types of MCDA approaches including: ELimination and Choice Expressing Reality (ELECTRE), Multi-Attribute Utility Theory (MAUT), Analytic Hierarchy Process (AHP), Measuring Attractiveness by a Categorical Evaluation Technique (MACBETH), Preference Ranking Organization METHod for Enrichment of Evaluations (PROMETHEE) and many others.

Phelps and Madhavan also describe how MCDA could be incorporated into health care decision-making. 

• Conduct direct comparisons of MCDA and CEA to see where the approaches produce similar answers and where the approaches produce different answers.
• Building the MCDA capability through more commonly available data resources, increased number of researchers with MCDA skills, increased validation of tools and improving human factor dimensions (e.g., ease of use, comprehensibility).
• Understanding how different voting methods perform when used to implement MCDA models in group settings.

MCDA may be especially useful when some key attributes of MCDA-informed value include cost or benefits received by society, but that are not captured by individual decision making.

• Charles E. Phelps and Guruprasad Madhavan. Valuing Health: Evolution, Revolution, Resistance, and Reform. Value in Health. 2019; 22(5):505–510.