MCDA for Resource Allocation at a Local Level: An Application in the UK

Introduction: Resource allocation at a local level involves making difficult decisions about investment and, particularly in a time of economic stringency, about disinvestment. These complex decisions are influenced by a number of local, political and contextual factors. The use of MCDA can support the local decision-makers to allocate their resources in a rational manner, based on explicit consideration of their priorities. Overview: This chapter provides an overview of methods for decision-making of relevance to health priority setting in local authorities. These methods have typically been developed in health-care independent of MCDA but share a number of similarities. Priority-setting approaches which draw on MCDA techniques include option appraisal, Portsmouth scorecard, prioritisation matrices, programme budgeting and marginal analysis (PBMA), sociotechnical allocation of resources (Star) and discrete choice experiments (DCEs). Whilst these applications are all based on MCDA, they vary significantly in terms of scientific rigour, robustness and time and other resources required. Case Study: The case study (entitled SYMPLE) describes the MCDA approach used to inform a prioritisation process for smoking cessation interventions across four local government areas in South Yorkshire. Discussion: A number of MCDA methods exist for local resource allocation, ranging from quick and simple methods (e.g. direct methods) which can be performed in a couple of weeks and are based on subjective opinion to more complex methods like the HELP tool which was based on DCEs and robust evidence (systematic reviews, modelling and survey of general population) but took significantly longer to implement. The local decision-makers need to choose the appropriate method based on their resource/time constraints, scientific validity and significance and broader context of the decision problem.