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March 2016 (Volume 94)
Quarterly Article
Charles Phelps
Guruprasad Madhavan
Rino Rappuoli
Scott Levin
Edward Shortliffe
Rita Colwell
December 2024
Dec 19, 2024
Back to The Milbank Quarterly
Policy Points:
Context: Strategic planning in population health and public health practice often uses single indicators of success or, when using multiple indicators, provides no mechanism for coherently combining the assessments. Cost-effectiveness analysis, the most complex strategic planning tool commonly applied in public health, uses only a single metric to evaluate programmatic choices, even though other factors often influence actual decisions.
Methods: Our work employed a multicriteria systems analysis approach—specifically, multiattribute utility theory—to assist in strategic planning and priority setting in a particular area of health care (vaccines), thereby moving beyond the traditional cost-effectiveness analysis approach.
Findings: (1) Multicriteria systems analysis provides more flexibility, transparency, and clarity in decision support for public health issues compared with cost-effectiveness analysis. (2) More sophisticated systems-level analyses will become increasingly important to public health as disease burdens increase and the resources to deal with them become scarcer.
Conclusions: The teaching of strategic planning in public health must be expanded in order to fill a void in the profession’s planning capabilities. Public health training should actively incorporate model building, promote the interactive use of software tools, and explore planning approaches that transcend restrictive assumptions of cost-effectiveness analysis. The Strategic Multi- Attribute Ranking Tool for Vaccines (SMART Vaccines), which was recently developed by the Institute of Medicine and the National Academy of Engineering to help prioritize new vaccine development, is a working example of systems analysis as a basis for decision support.
Author(s): Charles Phelps, Guruprasad Madhavan, Rino Rappuoli, Scott Levin, Edward Shortliffe, and Rita Colwell
Keywords: systems analysis, population health, public health practice, cost-effectiveness
Read on Wiley Online Library
Volume 94, Issue 1 (pages 109–125) DOI: 10.1111/1468-0009.12182 Published in 2016
