Multicriteria decision analysis in the Italian healthcare context: a review of applications and methodological...

Multicriteria Decision Analysis (MCDA) has gained increasing relevance in healthcare as an approach for evaluating options across multiple criteria. This study aims to provide an overview of MCDA applications in Italy, examining their decision contexts, the preference elicitation methods employed, and the stakeholder groups involved. A literature review was conducted across PubMed and Google Scholar (searches up to November 2025), supplemented by Italian studies identified in an international systematic review. For each study, data were collected on publication year, decision context, preference elicitation methods, and stakeholder involvement. Nineteen studies met the eligibility criteria, 16 of which were published after 2017. Most applications concerned priority-setting decisions related to coverage, reimbursement or funding of healthcare interventions, particularly the evaluation of drugs, therapeutic products, and other health technologies. Preference elicitation methods were predominantly compositional, with direct rating and the Analytic Hierarchy Process being the most frequently applied techniques; decompositional approaches were rarely used. Approximately half of the studies implemented a multi-stakeholder approach. Clinicians were the most frequently included group, followed by healthcare providers, while other stakeholder categories, including patients, were less commonly involved. The use of MCDA in Italy is progressively increasing and generally aligns with global trends. However, important opportunities for further development remain. These include extending MCDA applications to earlier stages of the technology lifecycle, adopting more rigorous and robust preference elicitation techniques, and strengthening its multi-stakeholder orientation, particularly by enhancing patient involvement, in order to improve the methodological quality and policy relevance of future MCDA applications in the Italian context.