Moderator: Nancy Devlin, PhD, Professor, Director, Centre for Health Policy, University of Melbourne, Melbourne, Australia
Panelists: Charles Phelps, PhD, University Professor and Provost Emeritus, Economics, Public Health Sciences, University of Rochester, GUALALA, CA, USA; Adrian Towse, MA, MPhil, Director Emeritus and Senior Research Fellow, Office of Health Economics, London, UK
ISSUE: Should we continue to use (and improve) cost-effectiveness analysis as the primary method for technology evaluation, move to (and improve) multi-criteria decision analysis models?
OVERVIEW: HEOR is still a very long way from any consensus on the best methods for operationalising multiple criteria in decision making. We currently quantify cost per QALY but not other criteria or tradeoffs, with decisions ‘emerging’ from via committee deliberations. In this issues panel we debate two contrasting ways forward: expanding CEA in various ways, by weighting QALYs, or moving to an MCDA approaches. The panellists will set out how they would address budget constraints, and opportunity cost. How would they get ‘better’ decisions? Nancy Devlin will moderate and introduce the session as co-chair of the ISPOR Emerging Task Force on MCDA. She will set out pros and cons of MCDA versus conventional QALY-based CEA and deliberative processes, drawing on her Oxford Encyclopaedia of Economics and Finance review chapter, and experience advising HTA bodies and companies. Chuck Phelps will argue from his ViH 20th anniversary issue article “the future is MCDA not CEA”. Only a comprehensive MCDA model can integrate equity and unquantifiable aspects of value, significantly surpassing narrower, reductionist techniques such as CEA. Perfection is not necessary to begin expanding the use of MCDA across decision scenarios, and active use will speed the improvement of the approach. Adrian Towse will argue for use of weighted CEA built around the QALY, adding in monetary amounts using a threshold and expanding where possible conversion of other attributes of value either into QALYs or monetary units. This is consistent with a development of current deliberative processes.