Additive Multicriteria Decision Analysis Models: Misleading Aids for Life-Critical Shared Decision Making

Area of Science:

• Health decision science
• Medical ethics
• Health economics

Background:

• Shared decision making (SDM) increasingly utilizes multicriteria decision analysis (MCDA).
• Standard additive MCDA models are insufficient for health decisions involving life extension and health-related quality of life (HRQL).
• Many MCDA models originate from non-health fields, posing challenges for clinical application.

Purpose of the Study:

• To evaluate the suitability of different MCDA models for SDM in healthcare.
• To identify appropriate MCDA methods for complex treatment choices.
• To propose a reasonableness test for MCDA model applicability in life-critical decisions.

Main Methods:

• A case study of a prostate cancer patient's MCDA from 2017 was critically reviewed.
• Additive MCDA models and the linear quality-adjusted life-year (QALY) model were analyzed.
• A reasonableness test was applied: Can a treatment causing premature death be preferred over one with acceptable adverse effects?

Main Results:

• Additive MCDA models and the linear QALY model yielded significantly different treatment recommendations.
• Additive MCDA models failed the proposed reasonableness test.
• The linear QALY model passed the reasonableness test, indicating greater suitability.

Conclusions:

• MCDA application in healthcare involves both technical skill and contextual judgment.
• Practitioners must understand MCDA model limitations for appropriate selection in SDM.
• Additive MCDA models are inadequate for life-critical SDM; QALY models show promise with further research.