The document discusses how values are integrated into resource allocation decisions through multi-criteria decision analysis (MCDA). MCDA involves specifying criteria and weighting them to reflect values. Criteria must be clearly defined and allow comparison of alternatives. Applying the criteria results in scores that measure each alternative's net benefit, allowing for comparison across alternatives based on the criteria and weights. The goal is to make value judgments explicit and transparent.
2. Best outcomes vs.
fair chances?
Individual choice vs.
How much priority to collective good?
disease prevention?
Resource allocation decisions =
value-based decisions
Urgent vs. likelihood
of success?
Modest benefits for many vs.
significant benefits for a few?
Rule of rescue?
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3. How are values integrated in
resource allocation decisions?
Priority setting processes (such as PBMA
which will be presented in this workshop) are
based on formal comparisons of possible
courses of action i.e. possible investments or
disinvestments
These comparisons involve the application of
decision making or evaluation criteria
It is in the selection of these criteria and of
their weights that values are reflected
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4. Multi-Criteria Decision
Analysis (MCDA)
The comparison part of a priority setting
process such as PBMA uses MCDA
MCDA is well-suited to contexts that
involve multiple objectives (such as, for
example, health improvement, equity,
knowledge generation, staff safety…)
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5. Goal of MCDA
To produce recommendations regarding
resource allocation decisions that are as
relevant to decision-makers as possible
Where relevance is defined in terms of the
ability of the recommendations to reflect
the real life setting in which the decisions
have to be made (as opposed to a Random
Controlled Trial, for example)
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6. Principles of MCDA
All relevant information is included in
the process, acknowledging varying
degree of quality
Analysis can apply to a multitude of
possible alternatives
Objective is to produce a composite
assessment of each possible alternative
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7. Principles of MCDA (2)
Ignoring a specific consideration is
equivalent to assigning it a weight of
zero i.e. there is no getting away from
MCDA, the only choice is whether it will
done explicitly or not, and by who
Relevant considerations directly linked
to the scope of the decisions required
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8. MCDA Criteria
Basis for process recommendations
Must be specified at outset of process
Must be explicitly weighted
Operational enough to assess proposals
Should not overlap (mutually exclusive)
Need to be clearly defined
Rating scale specific to each criterion
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9. Criteria
Basis for process recommendations
Points to the importance of aligning criteria
with organizational objectives and
reflecting social values as the criteria will
determine the direction of the resource
allocation
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10. Criteria
Must be specified at outset of process
Criteria do not vary by proposal for change.
All criteria are applied to all possible
courses of action considered. Allows
comparisons of totally disparate courses of
action
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11. Criteria
Must be explicitly weighted
Relative importance of criteria should be identified.
Weighting can’t be avoided- no weighting is accepting
equal weights
Methods to elicit relative importance weight
for criteria
Relative importance should be plausible and
intuitive
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12. Criteria
Operational enough to assess proposals
Criteria are not selected on the basis of the
availability of data or evidence but on the
relevance to the decision making process.
However, criteria must be defined in a way
that allows the development of a
measurement metric.
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13. Criteria
Should not overlap (mutually exclusive)
Obvious overlap must be avoided. Some
overlap will exist. The goal is to avoid
obvious double counting yet remain
pragmatic- the process is designed for
decision makers not mathematicians.
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14. Criteria
Need to be clearly defined
Criteria must be defined with clarity
sufficient to ensure consistency of
interpretation both by stakeholders
submitting proposals for changes and by
reviewers
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15. Criteria
Rating scale specific to each criterion
Rating is not a “meet/does not meet” a given
criterion. Rating is about the impact in terms of
each criterion. And impact measurement is more
than “positive”, “null” or “negative”. Typically a
scale with 3 or 4 grades is sufficient to capture all
relevant information
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16. Results of the application of the
criteria
Each possible course of action (investment or disinvestment)
gets a score
The score provides a single measure of each possible
action’s net benefit or impact
The scores depend on the criteria and their weights
Scores are comparable across all courses of action because
net benefits are measured on the same basis
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17. Managing the evidence in MCDA
Education on process and expectations on
using evidentiary base
All relevant information is used
Business case template used for query
submission adapted to the process
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18. Summary
Priority setting involves values, it can’t be
avoided
Objective is to make these value
judgements explicit and transparent
Values are reflected in the decision making
or evaluation criteria and their weights
Criteria, in turn, determine content of
resource allocation recommendations
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