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Adopting Multicriteria Decision Analysis in Local Health Settings: A Literature Review for Hospital Value Analysis Decision Makers
  • Aaron Miller,
  • Margret Lo,
  • Teodor Grantcharov
Aaron Miller
University of Toronto

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Margret Lo
McMaster University
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Teodor Grantcharov
University of Toronto
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Introduction: Hospital value analysis teams aim to scope, appraise, and procure the most cost and clinically effective alternatives, but many rely on deliberative processes and lack the use of evaluation frameworks. Multi-criteria decision analysis can complement these processes through the provision of systematic, transparent, and empirical decision support. This literature review aims to understand the applications of MCDA in local contexts. Methods: Medline (OVID), EMBASE, CINAHL, PsycINFO, and Scopus were searched, and returned 2,246 studies, of which 110 were included for full-text review, and 17 were included in the final analysis. Data relating to the context in which the study was conducted, the composition of the MCDA model used, and the reported feasibility of the use of MCDA were extracted. Results: The use of MCDA for local healthcare contexts is a recent, interprofessional, and geographically agnostic phenomenon. Diagnostics, treatment, surgical approaches, performances and preferences, education approaches, and recovery targets were the primary decision problems addressed. A combination of models was employed, and qualitative data, literature review, expert opinion, and financial measurements were used to support data requirements. Facilitating reasoning and decision-making, service quality improvement, transparency, flexibility and adaptability, participation and buy in, and feedback about MCDA were identified as key adoption characteristics. Conclusion: MCDA has numerous emerging applications to support healthcare decision makers across different decision problems and to evaluate products and processes in local settings. This review provides considerations for uptake and implementation, though further investigation into its explicit applications to hospital and perioperative value analysis is necessary to elicit the usability, feasibility, and acceptability of these models.