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Priority setting of health interventions: the need for multi-criteria decision analysis

DOI: 10.1186/1478-7547-4-14

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Abstract:

This indicates the need for rational and transparent approaches to priority setting. Over the past decades, a number of approaches have been developed, including evidence-based medicine, burden of disease analyses, cost-effectiveness analyses, and equity analyses. However, these approaches concentrate on single criteria only, whereas in reality, policy makers need to make choices taking into account multiple criteria simultaneously. Moreover, they do not cover all criteria that are relevant to policy makers.Therefore, the development of a multi-criteria approach to priority setting is necessary, and this has indeed recently been identified as one of the most important issues in health system research. In other scientific disciplines, multi-criteria decision analysis is well developed, has gained widespread acceptance and is routinely used. This paper presents the main principles of multi-criteria decision analysis. There are only a very few applications to guide resource allocation decisions in health. We call for a shift away from present priority setting tools in health – that tend to focus on single criteria – towards transparent and systematic approaches that take into account all relevant criteria simultaneously.Pertaining health needs and accelerating technological development put an ever-increasing demand on limited health budgets. Policy makers need to make important decisions on the use of public funds – to target which disease areas, which populations, and with which interventions. However, these choices may not be based on a rational and transparent process, and resources may not be used to an optimal extent [1,2]. For example, despite evidence that investing in primary health care is more effective than investing in specialized health care, allocations to primary care in Ghana have remained behind those allocated to tertiary care [3]. The underlying problem is that decisions on the choice of health interventions are complex and multifaceted [4,5], and th

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