Baltussen and others have proposed that multi-criteria decision analysis (MCDA) can improve priority setting processes [1,2,3]. Other approaches include cost-effectiveness analysis [4, 5], criteria-based systems that include cost-effectiveness and other concerns [6,7,8,9], programme budgeting and marginal analysis (PBMA) , procedural frameworks such as accountability for reasonableness , and rights-based approaches .
For example, the World Health Organization and the World Bank have championed cost-effectiveness as a key criterion for global and national priority setting [4, 5]. In UK, the National Institute for Health and Care Excellence (NICE) identifies the most cost-effective services through health technology assessment, with input on key values from the Citizen’s Council. In Thailand, the Health Intervention and Technology Assessment Program (HITAP) appraises a wide range of health technologies and public health programs by six criteria: size of population affected, severity of disease, effectiveness of health intervention, variation in practice, economic impact on household expenditure, and equity and social implications [8, 9].
Common for all priority setting approaches is that they seek to provide a ranking of services delivered at different levels of the health system by linking evidence on needs and outcomes with values, principles, and criteria that have support in the population. The approaches differ along at least two axes: (1) technical versus deliberative, and (2) narrow focus versus comprehensive.
MCDA as discussed in this issue of the journal have moved from a more technical framework with a narrow focus towards a deliberative framework allowing for discussion and use of a wide range of criteria and concerns . In my view, MCDA has moved too far from its origin. In the further development of MCDA tools, four critical questions therefore need further scrutiny.