Examination of Multiple Criteria in Health Technology Assessment for Application to Instrumental Analysis

Abstract:

The instrumental-ceremonial dichotomy is the analytical concern emphasized in instrumental analysis by original institutional economists for making welfare decisions. Paul Dale Bush and Wolfram Elsner explained that warranted criteria are required in order to conduct instrumental analysis. The concern for criteria led to an examination of multiple criteria decision analysis in health technology assessment in order to improve instrumental analysis. Health technology assessment (HTA) is one of the most active and extensive areas of analysis for policy making because medical technology changes very rapidly, expenditures on it are high and growing, it can harm as well as help, and there is intense personal concern by citizens who want wellness. Although HTA, especially with regard to the analysis of multiple criteria, has made considerable progress, its appraisal has been a disappointment. Thus, the purpose of this paper is to critique aspects of multiple criteria HTA in order to further develop instrumental analysis.

Keywords:

• criteria
• cost/effectiveness
• health technology
• instrumentalism

JEL Classification Codes:

• B52
• I18
• O33
• O35
• Z13

Notes

1 An expanded explanation of the evolution of OIE to complex systems with multiple criteria can be found in F. Gregory Hayden and Erin Johnson (2020).

2 The paper prepared by Robert Kemp (2019) for delivery at the 2019 Association for Institutional Thought meeting, about criteria in HTA, led to the examination of MCDA in HTA in order to improve instrumental analysis.

3 With regard to the history of HTA, Robert Kemp stated: “As more central health authorities require comprehensive evaluation of health care technologies, they are moving away from their initial attraction to simple reductionist models based on cost-benefit arithmetic to open models reflecting the complexity of the decisions at hand and toward the open-systems modelling that inspired Hayden in his construction of the social fabric matrix approach” (Kemp 2019).

4 The criteria utilized in the formula are taken from the United Kingdom National Institute for Health and Clinical Excellence assessment process.

5 To demonstrate an applied example of Formula 1, Thokala and Daenas (2012) present a numerical expression for technology a as follows:

$$\mathrm{V}(\mathrm{a})=\sum (8\times 0.72)+(1\times 0.14)+(3\times 0.19)+(2\times 0.93)+(3\times 0.82)=12.92$$

6 In addition to the weight assigned in HTA to the C/E variable, the prices used to arrive at cost also serve as weights. Exploitive prices charged by monopolistic and oligopolistic firms are examples that need to be adjusted before cost figures are accepted.

7 The Patient Protection and Affordable Care Act (Obama Care) banned the use of C/E analysis by government agencies to complete HTA for different reasons than the concerns discussed here (Neumann and Weinstein 2010).

Additional information

Notes on contributors

F. Gregory Hayden

F. Gregory Hayden is a professor of economics at the University of Nebraska-Lincoln