Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis

E.H.A. van den Bogaart*, M.E.A.L. Kroese, M.D. Spreeuwenberg, D. Ruwaard, A. Tsiachristas

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: To experiment with new approaches of collaboration in healthcare delivery, local authorities implement new models of care. Regarding the local decision context of these models, multi-criteria decision analysis (MCDA) may be of added value to cost-utility analysis (CUA), because it covers a wider range of outcomes. This study compares the 2 methods using a side-by-side application.Methods: A new Dutch model of care, Primary Care Plus (PC+), was used as a case study to compare the results of CUA and MCDA. Data of patients referred to PC+ or care-as-usual were retrieved by questionnaires and administrative databases with a 3-month follow-up. Propensity score matching together with generalized linear regression models was used to reduce confounding. Univariate and probabilistic sensitivity analyses were performed to explore uncertainty in the results.Results: Although both methods indicated PC+ as the dominant alternative, complementary differences were observed. MCDA provided additional evidence that PC+ improved access to care (standardized performance score of 0.742 vs 0.670) and that improvement in health-related quality of life was driven by the psychological well-being component (standardized performance score of 0.710 vs 0.704). Furthermore, MCDA estimated the budget required for PC+ to be affordable in addition to preferable (V521.42 per patient). Additionally, MCDA was less sensitive to the utility measures used.Conclusions: MCDA may facilitate an auditable and transparent evaluation of new models of care by providing additional information on a wider range of outcomes and incorporating affordability. However, more effort is needed to increase the usability of MCDA among local decision makers.
Original languageEnglish
Pages (from-to)795-803
Number of pages9
JournalValue in Health
Issue number6
Publication statusPublished - 1 Jun 2021


  • cost-utility analysis
  • health services research
  • local decision-making
  • multi-criteria decision analysis
  • new models of care
  • MCDA
  • EQ-5D


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