Using a Fuzzy Approach in Multi-Criteria Decision Making with Multiple Alternatives in Health Care

• Authors: Michał Jakubczyk
• Languages of publication: EN

Abstracts

EN

One of the responsibilities of the health care sector regulator is to decide which health technologies (drugs, procedures, diagnostic tests, etc.) should be financed using public resources. That requires taking into account multiple criteria, of which two important ones are: cost and effectiveness of a technology (others being, e.g., prevalence, safety, ethical and social implications). Hence, health and wealth need to be traded off against each other, and hence the willingness-to-pay (WTP) has to be determined. Various approaches to setting WTP have been taken, yet the results differ substantially. In the present paper I claim that the proper approach is to treat WTP as a fuzzy concept (the decision maker may not be able to decidedly state that a given health-wealth trade-off coefficient is acceptable/unacceptable - an idea backed up by the survey presented in the paper). Previous research shows how this fuzzy approach can be embedded in defining the preference relation and pairwise comparisons. In the present paper I account for the fact that there are often more than two alternatives available. To avoid difficulties that might arise (e.g., incompleteness or intransitivity of preferences) I show how the fuzzy approach can be used to define a fuzzy choice function based on the axiomatic approach. Some properties are discussed (e.g., how the approach handles the dominance and extended dominance), and the directions of further research are hinted at.

Keywords

EN

Cost effectiveness; Fuzzy sets; Health care financing; Health care protection; Medical technology

PL

Efektywność kosztowa; Finansowanie ochrony zdrowia; Ochrona zdrowia; Technologia medyczna; Zbiory rozmyte

• Publisher: Uniwersytet Ekonomiczny w Katowicach
• Journal: Multiple Criteria Decision Making
• Year: 2015
• Volume: 10
• Pages: 65-81

Contributors

author

Michał Jakubczyk

References

• Garber A. (2000), Advances in Cost-Effectiveness Analysis of Health Interventions [in:] A.J. Culyer, J.P. Newhouse (ed.), Handbook of Health Economics, Volume 1A, 181-221, Elsevier, North Holland.
• Gold M.R., Siegel J.E., Russell L.B., Weinstein M.C. (ed.) (1996), Cost-Effectiveness in Health and Medicine, Oxford University Press, USA.
• Tan-Torres Edejer T., Baltussen R., Adam T., Hutubessy R., Acharya A., Evans D.B., Murray C.J.L. (ed.) (2003), WHO Guide to Cost-Effectiveness Analysis, World Health Organization, Geneva.
• WHO (2001), Macroeconomics and Health: Investing in Health for Economic Development. Report of the Commission on Macroeconomics and Health.
• Arrow K.J. (1963), Uncertainty and the Welfare Economics of Medical Care, The American Economic Review, 53 (5), 941-973.
• Barton G., Briggs A., Fenwick E. (2008), Optimal Cost-effectiveness Decisions: The Role of the Cost-effectiveness Acceptability Curve (CEAC), the Cost-effectiveness Acceptability Frontier (CEAF), and the Expected Value of Perfect Information (EVPI), Value in Health, 11 (5), 886-897.
• Bellavance F., Dionne G., Lebeau M. (2009), The Value of a Statistical Life: A Meta-analysis with a Mixed Effects Regression Model, Journal of Health Economics, 28 (2), 444-464.
• Bleichrodt H., Wakker P., Johannesson M. (1997), Characterizing QALYs by Risk Neutrality, Journal of Risk and Uncertainty, 15, 107-114.
• Buxton M.J., Drummond M.F., Hout B.A. van, Prince R.L., Sheldon T.A., Szucs T., Vray M. (1997), Modelling in Economic Evaluation: An Unavoidable Fact of Life, Health Economics, 6 (3), 217-227.
• Claxton K., Martin S., Soares M., Rice N., Spackman E., Hinde S., Devlin N., Smith P.C., Sculpher M. (2015), Methods for the Estimation of the National Institute for Health and Care Excellence Cost-effectiveness Threshold, Health Technology Assessment, 19 (14), DOI: 10.3310/ hta19140.
• Dakin H.A., Devlin N.J., Odeyemi I.A.O. (2006), "Yes", "No" or "Yes, but"? Multinomial Modelling of NICE Decision-making, Health Policy, 77, 352-367.
• Devlin N., Parkin D. (2004), Does NICE Have a Cost-effectiveness Threshold and What Other Factors Influence Its Decisions? A Binary Choice Analysis, Health Economics, 13, 437-452.
• Eckermann S., Willan A.R. (2011), Presenting Evidence and Summary Measures to Best Inform Societal Decisions When Comparing Multiple Strategies, Pharmacoeconomics, 29 (7), 563-577.
• Fenwick E., Claxton K., Sculpher M. (2001), Representing Uncertainty: The Role of Costeffectiveness Acceptability Curves, Health Economics, 10 (8), 779-787.
• Hoch J.S., Blume J.D. (2008), Measuring and Illustrating Statistical Evidence in a Costeffectiveness Analysis, Journal of Health Economics, 27, 476-495.
• Hout B. van, Al M., Gordon G., Rutten F. (1994), Costs, Effects and C:E-ratios alongside a Clinical Trial, Health Economics, 3, 309-319.
• Jakubczyk M., Kamiński B. (2010), Cost-Effectiveness Acceptability Curves-caveats Quantified, Health Economics, 19, 955-963.
• Jakubczyk M., Kamiński B. (2015), Fuzzy Approach to Decision Analysis with Multiple Criteria and Uncertainty in Health Technology Assessment, Annals of Operations Research, doi: 10.1007/s10479-015-1910-9.
• Karlsson G., Johannesson M. (1996), The Decision Rules of Cost-Effectiveness Analysis, Pharmacoeconomics, 9 (2), 113-120.
• Lee C.P., Chertow G.M., Zenios S.A. (2009), An Empiric Estimate of the Value of Life: Updating the Renal Dialysis Cost-Effectiveness Standard, Value in Health, 12 (1), 80-87.
• Niewada M., Polkowska M., Jakubczyk M., Golicki D. (2013), What Influences Recommendations Issued by the Agency for Health Technology Assessment in Poland? A Glimpse Into Decision Makers' Preferences, Value in Health Regional Issues, 2 (2), 267-272.
• Pliskin J.S., Shepard D.S., Weinstein M.C. (1980), Utility Functions for Life Years and Health Status, Operations Research, 28 (1), 206-224.
• Sadatsafavi M., Najafzadeh M., Marra C. (2008), Acceptability Curves Could Be Misleading When Correlated Strategies Are Compared, Medical Decision Making, 28 (3), 306-307.
• Viscusi W.K., Aldy J.E. (2003), The Value of a Statistical Life: A Critical Review of Market Estimates Throughout the World, The Journal of Risk and Uncertainty, 27 (1), 5-76.
• Ustawa z dnia 12 maja 2011 r. o refundacji leków, środków spożywczych specjalnego przeznaczenia żywieniowego oraz wyrobów medycznych, http://isap.sejm.gov.pl/DetailsServlet?id= WDU20111220696 (7.04.2015).

Identifiers

ISSN

2084-1531