Concept Architecture
Concept
Theoretically, Multi-Criteria Decision Analysis (MCDA) in Health Technology Assessment (HTA) is a structured decision-making framework that evaluates health technologies against multiple explicit criteria rather than a single measure such as cost-effectiveness. It integrates evidence on clinical effectiveness, safety, costs, equity, feasibility and other decision criteria using a transparent weighting and scoring process. The framework exists to support complex reimbursement and policy decisions where multiple dimensions of value must be considered simultaneously.
Mathematically, MCDA in HTA represents overall value as the aggregation of criterion-specific performance scores weighted according to their relative importance. The most widely recognised mathematical representation is the weighted additive value model, although other aggregation methods such as multiplicative models, outranking methods and analytic hierarchy process-based approaches are also used. The resulting composite value score provides a quantitative basis for comparing alternative health technologies.
In practice, MCDA is implemented by defining evaluation criteria, assigning stakeholder-derived weights, measuring the performance of each technology on each criterion and calculating an overall value score. Weights are commonly elicited using recognised preference elicitation methods, while performance scores are derived from clinical evidence, economic evaluations and expert judgement. MCDA is increasingly used alongside conventional HTA methods to improve transparency and consistency in healthcare decision-making.
Purpose
Used to evaluate health technologies across multiple dimensions of value, support transparent reimbursement decisions, incorporate stakeholder preferences, compare competing interventions and complement conventional health economic evaluation within HTA.
Mathematical Formulae
Primary Formula
V(a) = ?(w? ? s?(a))
where:
- V(a) = overall value score for alternative a
- w? = weight assigned to criterion i
- s?(a) = performance score of alternative a on criterion i
Supporting Formulae
?w? = 1
Normalised Score = (x ? min) � (max ? min)
Related Mathematical Methods
- Weighted additive value model
- Multi-attribute value theory (MAVT)
- Multi-attribute utility theory (MAUT)
- Analytic Hierarchy Process (AHP)
- Swing weighting
- Direct rating
- Outranking methods (ELECTRE, PROMETHEE)
- Preference elicitation
Example
An HTA committee evaluates two medicines using four criteria:
| Criterion | Weight | Medicine A Score |
|---|---|---|
| Clinical effectiveness | 0.40 | 90 |
| Safety | 0.20 | 80 |
| Cost-effectiveness | 0.25 | 70 |
| Equity | 0.15 | 60 |
Overall value:
V(A) = (0.40 ? 90) + (0.20 ? 80) + (0.25 ? 70) + (0.15 ? 60)
= 36 + 16 + 17.5 + 9
= 78.5
Medicine A therefore receives an overall MCDA value score of 78.5, which may be compared directly with competing technologies during the HTA process.
Excel Implementation
| Function | Example Formula | Health Economics Application |
|---|---|---|
| SUMPRODUCT | =SUMPRODUCT(B2:B5,C2:C5) | Calculate the overall weighted MCDA value score. |
| SUM | =SUM(B2:B5) | Verify that criterion weights sum to one. |
| MIN | =MIN(C2:C10) | Determine the minimum criterion score for normalisation. |
| MAX | =MAX(C2:C10) | Determine the maximum criterion score for normalisation. |
| IF | =IF(SUM(B2:B5)=1,"Valid","Check Weights") | Validate the weighting scheme before analysis. |
VBA (Optional)
Automate MCDA calculations by importing technology assessments, validating criterion weights, calculating composite value scores and producing ranked HTA reports.
Sources
- Belton V, Stewart TJ. Multiple Criteria Decision Analysis: An Integrated Approach. Springer.
- Keeney RL, Raiffa H. Decisions with Multiple Objectives: Preferences and Value Trade-Offs. Cambridge University Press.
- Marsh K, IJzerman M, Thokala P, et al. Multiple Criteria Decision Analysis for Health Care Decision Making. Value in Health.
- ISPOR MCDA Emerging Good Practices Task Force Reports.
- NICE. Health Technology Evaluation Manual.
- Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes.
Related Concepts (2)
Library
Publications
1
NICE Health Technology Evaluations: The Manual (PMG36) — National Institute for Health and Care Excellence, PMG36 ed., 2022 (NICE)
NICE’s consolidated methods and processes manual for health technology evaluation, defining the reference case for economic evaluation (perspective, comparators, time horizon, discounting, EQ-5D, cost-effectiveness thresholds and the severity modifier) — the authoritative HTA methods reference for the English NHS.
Frequently Asked Questions (6)
What is MCDA in HTA?
MCDA in HTA is the application of multi-criteria decision analysis within assessment, weighing multiple factors such as benefit, cost, and equity together explicitly. It weighs several factors explicitly. Described in health technology assessment, MCDA weighs multiple factors together explicitly. So MCDA in HTA is the application of multi-criteria decision analysis within an assessment, weighing multiple factors such as benefit, cost, and equity together in an explicit way rather than considering them informally.
Source: Thokala et al. 2016
What does MCDA bring to a health technology assessment?
MCDA in HTA is the use of multi-criteria decision analysis within an assessment, weighing several factors such as benefit, cost, and equity together in an explicit way. It brings a structured method for bringing many considerations into a single, transparent judgement, rather than letting cost-effectiveness alone decide. It is explicit because each factor and its weight are set out openly, so the reasoning can be seen and challenged. It draws in factors that a narrow economic analysis would leave out, such as fairness and severity. It is the application, within HTA, of multi-criteria decision analysis, the general technique. Weighing many factors openly is what it brings. Thokala and colleagues (2016) set this out.
Source: Thokala et al. 2016
What does MCDA in HTA weigh?
MCDA in HTA weighs multiple factors such as benefit, cost, and equity together explicitly, so it brings these factors into the assessment and weighs them in a defined, explicit way. So MCDA in HTA weighs benefit, cost, and equity explicitly, which is why it is multi-criteria, since several factors are weighed, and MCDA in HTA weighs multiple factors such as benefit, cost, and equity together explicitly.
Source: Thokala et al. 2016
Why is MCDA in HTA explicit?
MCDA in HTA is explicit so the weighing of factors such as benefit, cost, and equity is done in a defined, transparent way rather than informally, making the basis of the assessment clear. So MCDA in HTA is explicit for transparency, which is why it weighs factors formally, since explicit weighing is clearer, and MCDA in HTA weighs multiple factors explicitly rather than informally, weighing them together rather than considering one in isolation.
Source: Thokala et al. 2016
What factors does MCDA in HTA bring in?
MCDA in HTA brings in multiple factors such as benefit, cost, and equity, so it considers these together explicitly rather than focusing on one, such as cost-effectiveness, alone. So MCDA in HTA brings in benefit, cost, and equity, which is why it is multi-criteria, since it weighs several factors, and MCDA in HTA brings in multiple factors such as benefit, cost, and equity, weighing them together explicitly.
Source: Thokala et al. 2016
How does MCDA in HTA relate to multi-criteria decision analysis?
MCDA in HTA relates to multi-criteria decision analysis as its application within assessment: multi-criteria decision analysis is a structured framework weighing options across multiple criteria, and MCDA in HTA applies it within an assessment to weigh factors such as benefit, cost, and equity. So MCDA in HTA applies multi-criteria decision analysis, which is why they are connected, since one is the method and the other its use in HTA, and MCDA in HTA is the application of multi-criteria decision analysis within the assessment process.
Source: Thokala et al. 2016
Trust Record
Verified by Dr Darrin Baines
British health economist
Professional identity: darrinbaines.org
Verification date: 10 Feb 2026
Content version: 1.0.0
Canonical Identity
- Persistent URI
- https://healtheconomics.wiki/concept/mcda-in-hta
- Term code
- HS-HP-HTA-127
Stable URI · Machine-readable · Resolvable · CC BY 4.0