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)
Frequently Asked Questions (6)
What is multi-criteria analysis in HTA?
Multi-criteria analysis in HTA is the application of multi-criteria decision analysis within assessment, explicitly incorporating and weighing multiple decision factors beyond cost-effectiveness alone. It weighs several factors, not just cost-effectiveness. Described in health technology assessment, multi-criteria analysis weighs multiple factors beyond cost-effectiveness. So multi-criteria analysis in HTA is the application of multi-criteria decision analysis within an assessment, explicitly incorporating and weighing multiple decision factors rather than relying on cost-effectiveness alone.
Source: Thokala et al. 2016
What does multi-criteria analysis add to an assessment beyond cost-effectiveness?
Multi-criteria analysis in HTA is the use of multi-criteria decision analysis within an assessment, adding explicit consideration of factors beyond cost-effectiveness alone. It incorporates and weighs several decision factors together, so that matters such as severity, equity, and unmet need count alongside value for money. It goes beyond cost-effectiveness because a single ratio cannot capture everything that should bear on a funding decision. It weighs the factors by assigning them explicit importance and combining them, making the trade-offs visible. It is, in substance, the same as MCDA in HTA, the application of the technique within assessment. Broadening the basis of a decision is what it does. Thokala and colleagues (2016) set this out.
Source: Thokala et al. 2016
What does multi-criteria analysis in HTA incorporate?
Multi-criteria analysis in HTA explicitly incorporates and weighs multiple decision factors beyond cost-effectiveness alone, so it brings additional factors into the assessment and weighs them along with cost-effectiveness. So multi-criteria analysis in HTA incorporates multiple factors beyond cost-effectiveness, which is why it is multi-criteria, since it weighs several, and multi-criteria analysis in HTA explicitly incorporates and weighs multiple decision factors beyond cost-effectiveness alone, so the assessment reflects more than cost-effectiveness alone.
Source: Thokala et al. 2016
Why does multi-criteria analysis in HTA go beyond cost-effectiveness?
Multi-criteria analysis in HTA goes beyond cost-effectiveness because a decision may depend on several factors, not cost-effectiveness alone, so incorporating and weighing multiple factors captures more of what matters. So multi-criteria analysis goes beyond cost-effectiveness to capture more factors, which is why it is multi-criteria, since several factors matter, and multi-criteria analysis in HTA incorporates multiple decision factors beyond cost-effectiveness alone, making the basis of the assessment clear and transparent.
Source: Thokala et al. 2016
How does multi-criteria analysis in HTA weigh factors?
Multi-criteria analysis in HTA weighs multiple decision factors explicitly, so the factors beyond cost-effectiveness are brought in and weighed in a defined, transparent way rather than informally. So multi-criteria analysis weighs factors explicitly, which is why it is structured, since explicit weighing is clearer, and multi-criteria analysis in HTA explicitly weighs multiple decision factors beyond cost-effectiveness alone, both explicitly weighing multiple decision factors that go beyond cost-effectiveness alone.
Source: Thokala et al. 2016
How does multi-criteria analysis in HTA relate to MCDA in HTA?
Multi-criteria analysis in HTA relates to MCDA in HTA in that they describe the same thing: both apply multi-criteria decision analysis within assessment, explicitly weighing multiple factors such as benefit, cost, and equity beyond cost-effectiveness alone. So multi-criteria analysis in HTA and MCDA in HTA are the same concept, which is why they overlap, since both apply MCDA in assessment, and whether termed multi-criteria analysis in HTA or MCDA in HTA, it is the explicit weighing of multiple decision factors within an assessment.
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
- Term code
- HS-HP-HTA-131
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