Multi-criteria decision analysis to prioritize health interventions: Capitalizing on first experiences
Introduction
This paper capitalizes on a first set of experiences on the application of MCDA in seven low- and middle-income settings [1], [2], [3], [4], [5], [6], [7], building upon the conceptual basis of MCDA in health as described elsewhere [8]. It thereby responds to a recent paper by Peacock et al. [9] in this journal, in which the authors elaborate on the use of interdisciplinary methods to set priorities in health, and thereby highlight the potential of MCDA. We qualify a number of observations by Peacock et al. [9] on the types of policy questions MCDA can address, and on methodological aspects of MCDA. We also elaborate on the construction of a global database on intervention priorities.
Section snippets
Types of policy questions
Priority setting is sometimes referred to as a generic process on the rank ordering of interventions [10], but in reality covers a wide variety of policy questions at different levels of the health system. We distinguish two broad applications of priority setting studies: first, priority setting can be undertaken to inform policy makers in a specific context on e.g. the reimbursement of a single intervention, or to prioritize between only a few interventions, either at the national,
Methodological aspects
Peacock et al. [9] highlight the importance of participatory action research, and the involvement of stakeholders in decisions on intervention priorities. The inclusion of perspectives of relevant stakeholders – and where possible the achievement of consensus – is indeed important, to improve accountability, credibility and acceptability of results by society [14], [18], [19]. The recent MCDA study on the prioritization of HIV/AIDS interventions in Thailand followed up on this, and revealed
Towards a global database on intervention priorities
On the one hand, there will never be enough resources available to elicit preferences for criteria in all countries in the world. On the other hand, a single set of preferences for criteria would not adequately reflect socio-economic and cultural variations explaining these preferences. A question of interest is then whether general patterns exist on the preferences for priority setting criteria (both on the type of criteria, and their relative importance) between countries. Multi-country
Conclusion
Peacock et al. [9] have highlighted the usefulness of MCDA in context-specific priority setting, and we emphasize the potential of MCDA in generalized priority setting. First case-studies show the potential of MCDA to define general, national-level, criteria for priority setting, and provide broad classifications of intervention priorities. Important methodological challenges remain vis-à-vis the inclusion of different stakeholders and a comprehensive set of criteria. The construction of a
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