Deciding how to decide: Multi-Criteria Decision Analysis is probably the future for both Health Technology Assessment and Shared Clinical Decision Making

Abstract

I introduce JUDEMAKIA, a map of the world of Judgement and Decision Making, in which we can locate the full range of Belief Technologies, Preference Technologies and Decision Technologies in the framework provided by Ken Hammond’s Cognitive Continuum of changing Analysis to Intuition balances. Decision Analysis and particular implementations of Multi-Criteria Decision Analysis – MCDA (Analytic Hierarchy Process, Annalisa) - are then located on this map and some applications of MCDA in both the health service context (Health Technology Assessment - HTA) and clinical context (Shared Clinical Decision Making - SCDM) provided. Its advantages in transparently addressing the tensions in the simultaneous pursuit of Evidence-Informed, Preference-Based and Cost-Effective Care at both individual and population level are emphasised. Finally I introduce Decision Resource-Effectiveness Analysis (DREA). While Cost-Effectiveness Analysis focuses on the adoption decision - what should we do? - DREA targets the decision decision - how should we decide what to do? What is the appropriate way to decide which Decision Technology should be used for a specific decision in a specific context, given the relative weights assigned to intuition and analysis, rigour and relevance, complexity and practicality? MCDA emerges as the best way to tackle this meta-decision and undertake ‘Value of Analysis Analysis’.