'Multiple criteria decision analysis' is a crummy name for a great concept (aren't all big decisions analyzed using multiple criteria?). MCDA means assessing alternatives while simultaneously considering several objectives. It's a useful way to look at difficult choices in healthcare, oil production, or real estate. But oftentimes, results of these analyses aren't communicated clearly, limiting their usefulness (more about that below).
The International Society For Pharmacoeconomics and Outcomes Research (ISPOR) has developed new MCDA guidance, available in the latest issue of Value for Health (paywall). To be sure, healthcare decision makers have always weighed medical, social, and economic factors: MCDA helps stakeholders bring concrete choices and transparency to the process of evaluating outcomes research - where as we know, controversy is always a possibility.
Anyone can use MCDA. To put it mildly, it’s difficult to balance saving lives with saving money. Fundamentally, MCDA means listing options, defining decision criteria, weighting those criteria, and then scoring each option. Some experts build complex economic models, but anyone can apply this decision technique in effective, less rigorous ways.
You know those checklists at the end of every HouseHunters episode where buyers weigh location and size against budget? That's essentially it: People making important decisions, applying judgment, and weighing multiple goals (raise the kids in the city or the burbs?) - and even though they start out by ranking priorities, once buyers see their actual options, deciding on a house becomes substantially more complex.
MCDA gains traction in health economics. As shown in the diagram (source: ISPOR), the analysis hinges on assigning relative weights to individual decision criteria. While this brings rationality and transparency to complex decisions, it also invites passionate discussions. Some might expect these techniques to remove human judgment from the process, but MCDA leaves it front and center.
Looking for new ways to communicate health economics research and other medical evidence? Join me and other speakers at the 2nd annual HEOR Writing workshop in March.
Pros and cons. Let’s not kid ourselves: You have to optimize on something. MCDA is both beautiful and terrifying because it forces us to identify tradeoffs: Quality, quick improvement, long-term health benefits? Uncertain outcomes only complicate things further.
MCDA is a great way to bring interdisciplinary groups into a conversation. It's essential to communicate the analysis effectively, so stakeholders understand the data and why they matter - without burying them in so much detail that the audience is lost.
One of the downsides is that, upon seeing elaborate projections and models, people can become over-confident in the numbers. Uncertainty is never fully recognized or quantified. (Recall the Rumsfeldian unknown unknown.) Sensitivity analysis is essential, to illustrate which predicted outcomes are strongly influenced by small adjustments.
Resources to learn more. If you want to try MCDA, I strongly recommend picking up one of the classic texts, such as Smart Choices: A Practical Guide to Making Better Decisions. Additionally, ISPOR's members offer useful insights into the pluses and minuses of this methodology - see, for example, Does the Future Belong to MCDA? The level of discourse over this guidance illustrates how challenging healthcare decisions have become.
I'm presenting at the HEOR Writing workshop on communicating value messages clearly with data. March 17-18 in Philadelphia.