Alejandra Duenas ScHARR Is multi-criteria decision analysis applicable to public health decision making? Alejandra Duenas ScHARR

Outline What does NICE do? Developing NICE public health guidance Multi-criteria decision aid methods (MCDA) MCDA in public health Future work 13/11/2018 © The University of Sheffield

National Institute for Health and Clinical Excellence (NICE) “NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. NICE produces four types of guidance: technology appraisal guidance, clinical guidelines, interventional procedure guidance and public health guidance.” 13/11/2018 © The University of Sheffield

Examples of areas of public health Prevention and early identification of alcohol-use disorders in adults and young people Interventions for looked after children and young people 13/11/2018 © The University of Sheffield

Intervention/programme guidance development stages Scoping Development Validation Publication 13/11/2018 © The University of Sheffield

Aim of the scope clear definition of the intervention/programme background information what to exclude settings, practitioners and public health services guidance is responsive to public health policy and practice key questions for guidance development ensure guidance can be completed 13/11/2018 © The University of Sheffield

Development Public Health Collaborating Centre (ScHARR): evidence reviews economic analysis stakeholders submit additional evidence (4 weeks) 13/11/2018 © The University of Sheffield

Stakeholders draft scope synopsis of the reviews and economic analysis draft recommendations 13/11/2018 © The University of Sheffield

Public Health Interventions Advisory Committee considers and interprets effectiveness and cost effectiveness evidence formulates recommendations (public health interventions): NHS local government public health in England 13/11/2018 © The University of Sheffield

Public Health Interventions Advisory Committee 13/11/2018 © The University of Sheffield

Programme Development Group considers and interprets effectiveness and cost effectiveness evidence formulates recommendations (public health programmes): NHS local government public health in England 13/11/2018 © The University of Sheffield

Programme Development Group 13/11/2018 © The University of Sheffield

Guidance summary of evidence main conclusions overview of methodology recommendations for practice and research synopsis of evidence (evidence reviews and economic analysis) 13/11/2018 © The University of Sheffield

Guidance (cont) reviews of the evidence and economic analysis field work report implementation materials 13/11/2018 © The University of Sheffield

Multi-criteria decision aid methods UTilities Additives DIScriminantes (UTADIS) Analytic Hierarchy Process (AHP) Outranking methods 13/11/2018 © The University of Sheffield

Multi-criteria decision aid methods AHP - Example 13/11/2018 © The University of Sheffield

Multi-criteria decision aid (MCDA) 4 different decision problems: 13/11/2018 © The University of Sheffield

MCDA description ranking sorting choice 13/11/2018 © The University of Sheffield

MCDA description ranking sorting choice 13/11/2018 © The University of Sheffield

MCDA description ranking sorting choice 13/11/2018 © The University of Sheffield

MCDA description ranking sorting choice 13/11/2018 © The University of Sheffield

Example 13/11/2018 © The University of Sheffield

Example 13/11/2018 © The University of Sheffield

MCDA in public health To map the multitude of components: decision maker (DM) stakeholders objectives environment alternative courses of action public health 13/11/2018 © The University of Sheffield

MCDA in public health Articulation of the DM's preferences considering: goals aspiration levels mechanisms for overcoming barriers and constraints 13/11/2018 © The University of Sheffield

MCDA in public health 13/11/2018 © The University of Sheffield

DM’s preferences Membership function of fuzzy individual schedule fitness: 13/11/2018 © The University of Sheffield

Aspiration levels 13/11/2018 © The University of Sheffield

Fitness function definition Fuzzy set A = acceptable distance between the objective value and the aspiration level The membership function A represents the degree to which an achieved objective value satisfies the DM with respect to its distance from the aspiration level ALn. A ( ) 1 0.5  0.5 13/11/2018 © The University of Sheffield

Fitness function definition linguistically quantified statement = “most distances between the achieved objective values and the aspiration levels are acceptable” “Q ’s are A” Fitness function D is defined as: D(xv) = Truth[“Q ’s are A”] = Q( )  [0, 1] 13/11/2018 © The University of Sheffield

Fitness function definition Yager’s algebraic approach: For the quantifier “most”: Q( ) = 13/11/2018 © The University of Sheffield

Fitness function definition Find that maximises the degree of truth of the linguistically quantified fitness function: 13/11/2018 © The University of Sheffield

Group Decision Making 13/11/2018 © The University of Sheffield

Future work Analyse how to include uncertainty Analyse the group accordance Incorporate MCDA to public health decision making 13/11/2018 © The University of Sheffield