The Use of Multi-Criteria Decision Analysis (MCDA) to Support Decision-Making in Healthcare: an Updated Systematic Literature Review

Open AccessPublished:November 24, 2022DOI:
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      • Even though MCDA is increasingly used for decision-making in healthcare, its application in different decision contexts is still unclear. This updated systematic literature review examines the application of MCDA in healthcare by summarising the features of the decision context in which they were conducted, the MCDA methods applied, the stakeholders involved and the uncertainty analyses conducted.
      • The application of MCDA in healthcare continues to grow, with most studies informing priority-setting and clinical decisions. Most of the studies have been conducted in high-income countries, aiming at informing regulators or budget holders. As expected, there are considerable differences across decision contexts on the criteria used and some noticeable preferences for specific criteria sets. Nevertheless, considerable within-context variation was also found, which makes the comparison of MCDA results impossible
      • The value-measured approach continues to be the most frequently used, with scales and the analytic hierarchy process as the preferred techniques for scoring and weighting, respectively. Nevertheless, several studies did not report on the applied MCDA methods, used sources of information, and undertaken (or not) uncertainty analysis. These weaknesses in reporting undermine the transparency of the studies and raise questions about their methodological quality. A detailed methodological and reporting guidance by decision-context could be the next step from the existing ISPOR guidelines.



      Multi-Criteria Decision Analysis (MCDA) is increasingly used for decision-making in healthcare. However, its application in different decision-making contexts is still unclear.


      To provide a comprehensive review of MCDA studies performed to inform decisions in healthcare and to summarise its application in different decision-contexts.


      We updated a systematic review conducted in 2013 by searching EMBASE, Medline and Google Scholar for MCDA studies in healthcare, published in English between August 2013 and November 2020. We also expanded the search by reviewing grey literature found via Trip Medical Database and Google, published between January 1990 and November 2020. A comprehensive template was developed to extract information about the decision-context, criteria, methods, stakeholders involved, and sensitivity analyses conducted.


      From the 4,295 identified studies, 473 studies were eligible for full-text review after assessing titles and abstracts. Of those, 228 studies met inclusion criteria and underwent data extraction. The use of MCDA continues to grow in healthcare literature, with most (49%) of the studies informing priority-setting decisions. Safety, cost and quality of care delivery are the most frequently used criteria, although there are considerable differences across decision contexts. Almost half of the MCDA studies used the linear-additive model while scales and the analytic hierarchy process were the most used techniques for scoring and weighting, respectively. Not all studies report on each one of the MCDA steps, consider axiomatic properties or justify the methods used.


      A guide on how to conduct and report MCDA that acknowledges the particularities of the different decision-contexts and methods needs to be developed.