On September 6 to 8, 2015, it was held at the 5th Latin American Conference of the International Society for Pharmaeconomics and Outcomes Research, in Santiago, Chile. This year's theme was “Increasing Access to Health Care in Latin America: Making Better Decisions for Greater Equity.”
An important topic addressed at the conference was Multicriterion Decision Analysis (MCDA). This approach is characterized by the application of analytical methods that help stakeholders to consider, explicitly qualitatively or quantitatively, various criteria aimed at basing and outlining decision making.
It proposes the integration of two social values in the development of interventions in health, and is also achieved by promoting a structured and transparent assessment. The preferred alternative is identified based on the consideration of the relative importance attributed to each of the two components and the different criteria analyzed, as well as the performance of the alternatives.
The MCDA effort has been intended primarily for evaluations on coverage of health services and technologies, reimbursement and prescription, guiding decision-making in these different scenarios. Identifying its advantages and disadvantages becomes a fundamental process at this moment, since its use can become a new paradigm in the assessment of health technologies (ATS).
Firstly, the structure of the problem is carried out with the definition of the decision alternatives, the key questions, the objectives, the limitations and the uncertainties inherent in the decision process. Then, we proceed to a second stage with the search for evidence that contributes to the elucidation of the case, which is carried out through a literature review, meeting of stakeholders, the construction of models, or furthermore, through interviews with interested parties, including to the population.
From these initial steps, only the priority criteria are selected, these must be in an adequate number and their identification requires a clear conceptual definition, not having redundancies in this way. Subsequently, through different methods, weights were established for these different criteria, giving consideration to the preference of choosing one alternative to the detriment of another.
This can be represented by the construction and comparison of numerical scores, which were initially created for each criterion individually and, ultimately, aggregated into more complex models.
Once the approach is completed, a sensitivity and robustness analysis is carried out, and a summary of this information is prepared, thus allowing a better decision-making. It has been demonstrated by the Colombian experience in relation to the MCDA undertaking that it is not related to the coverage of technologies in health, tending to succeed in allying transparency and effective participation of stakeholders with a focus on the real demand and relevance of technologies, or that it has only become possible due to multiplicity. of points of view on the problem. These data referring to coverage make it possible to create a manual by this group.
However, it is identified that the selection of two criteria and the choice of method to obtain the weights remain challenges in practice, and that as we advance in the approach to MCDA ocorram, this emerging methodology will become not only accessible but also of great value. ao ambito da health.
For more information regarding MCDA, it is recommended that you read the material on Thokala and Duenas.
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