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Title: Multiple criteria approaches to public health decision-making
Author: Reddy, Brian P.
ISNI:       0000 0004 6062 638X
Awarding Body: University of Sheffield
Current Institution: University of Sheffield
Date of Award: 2017
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Aim: This thesis investigates if multiple criteria decision analysis (MCDA) techniques are suitable for use in public health (PH) decision-making settings in England, at the level of the National Institute for Health and Care Excellence (NICE) and in local government (LG). Background: MCDA techniques have not previously been widely used in such settings, though a number of benefits are reported where used for other complex decision problems. A variety of approaches are available, each with their own advantages, and these should be chosen according to the problem's context. Method: The thesis reports: non-systematic and systematic reviews of MCDA approaches in PH worldwide; on a secondment in NICE describing contextual factors that could influence the practicality of any attempts to implement MCDA approaches there; a review of all prior NICE PH economic models; a pilot project to structure NICE's topic appraisal stage using MCDA; an action research project applying an MCDA approach to prioritise programmes at LG level, and; overall findings. Results: MCDA approaches have been previously used in other PH settings, though generally on a once-off basis. NICE are often assumed to base their decisions primarily on interventions' cost-effectiveness - but a large number of other criteria, including non-health factors, were found to be considered. Economic models regularly veered from NICE's reference case, and used a variety of evaluation techniques and perspectives. MCDA approaches, when paired with deliberation, may offer a number of advantages over deliberation alone. The topic appraisal pilot found the approach to be technically feasible. The LG-level project was also successful and led to changes to the interventions offered to reduce tobacco prevalence in four boroughs. Conclusions: MCDA approaches are shown to be accessible and understandable to national and local PH decision-makers, as well as acceptable and implementable. They can therefore be considered suitable in at least some such settings.
Supervisor: Walters, Stephen J. ; Thokala, Praveen ; Kelly, Michael P. ; Duenas, Alejandra Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available