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Priority Setting for Health Related Investments: A Review of Methods

One of the first tasks in ranking and choosing among health related investments is selection of an appropriate method. Several methods have been applied successfully to problems conceptually similar to that of setting priorities for accelerated development of vaccines. Examples of these problems include setting priorities for resource allocation to medical technologies; setting priorities in medical research; selecting chemicals for toxicity testing; and selecting hazardous waste sites for clean-up. The methods themselves draw from techniques in systems analysis, decision analysis, and cost-benefit analysis. (Selected applications are described in Appendix A.)

Methods for Project Ranking and Selection

The five methods considered for use in ranking vaccine candidates are described below. They are (1) multiattribute accounting; (2) multiattribute scoring; (3) decision analysis with multiple objectives; (4) cost-effectiveness and cost-utility analysis; and (5) benefit-cost analysis. They differ from one another in several ways, most notably the extent of quantification demanded and the extent to which the ranking procedure is fashioned to reflect particular normative rules. The last part of this chapter considers some general issues in implementing any ranking methodology, including sources of estimates, appropriate use of sequential or “lexicographic” methods, problems of interdependence among projects, and the “portfolio” question.

Multiattribute Accounting

The ranking method requiring the least quantification and demanding the fewest normative assumptions is multiattribute accounting. This approach arrays the performance of each alternative on each valued objective, without attempting to produce an explicit overall score for each alternative. In deferring the final ranking to decision makers or consensus panels, multiattribute accounting differs from the other



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