Decision sciences: tools to foster value-based health care

Did you know that at the Centre for Management Studies of Instituto Superior Técnico, Portugal, decision sciences are used to develop tools to promote value-based health care?

Health stakeholders in multiple countries are discussing the need to devote more resources to health, to redistribute resources, to devise actions and policies to improve efficiency, access and quality, in line with promoting resilient health systems that balance access to care with innovation and sustainability.

Furthermore, it is consensual among health stakeholders that systems and institutions should evolve towards value-based health care. In order to address these challenges, tools that provide methods from both management science and operational research are required. This includes tools such as simulation, optimisation, structuring methods and multi-criteria decision analysis, which have shown to be essential to model health systems and improvements, and to evaluate changes. Nevertheless, the use of such methods by health organisations and decision-makers is still limited.

The DNA of the decision sciences group (DSG) at the Centre for Management Studies of Instituto Superior Técnico (CEGIST) is to develop knowledge, methods and software for improved decision support, with a particular interest on the development of methods towards value-based health care. CEG-IST is harboured within the IST engineering environment, exploring and reinforcing links between management science and engineering, and promoting applied research. Under this context, theories and methodologies are developed and tested in real contexts and/or using real data; and historically has been promoting collaborations with national and international organisations in health and health care, including with medical schools and health organisations and companies.

Key approaches

At the core of the DSG’s activity has been the development of multi-methodologies, decision support systems and tailored solutions to address problems of health decision- and policy-makers. One of the key methodologies used and enhanced by the group is MACBETH, a multicriteria value measurement approach that requires only qualitative judgments from individuals to evaluate options on multiple criteria. MACBETH has proven to be a powerful tool for performance and value measurement, project evaluation and prioritisation, resource allocation and budgeting, risk analysis, and policy design and strategic choice. Furthermore, the decision sciences group has been developing approaches to ensure health stakeholders’ and decision-makers’ participation within a collaborative value modelling framework that combines Web-Delphi and decision conferencing processes.

The research team has been developing research in collaboration with multiple private and public institutions, and one herein recalls a sample of projects in which the group has been involved to illustrate how decision sciences research can assist real health stakeholders and decision-makers. The projects highlighted below show the scope for developing management science tools to enable health organisations and decision-makers (either in policy, managerial and clinical settings) to make better decisions aligned with the prosecution of several objectives and while fostering participation within a value-based health care philosophy.

Fig 1. Screens reflecting the use of the MACBETH approach (left) and Web-Delphi processes (right) used in the EURO-HEALTHY project to model population health across European regions and to obtain experts’ views regarding the value function for the indicator ‘Unemployment rate’ (source: Vieira, A., et al. (2019). “Enhancing knowledge construction processes within multicriteria decision analysis: The collaborative value modelling framework” Omega: The International Journal of Management Science,


In order to inform the European Union about the plausible scenarios for population health inequalities across Europe, and how policies can be devised to improve population health and decrease health inequalities in Europe, the group devised a set of multicriteria, foresight and optimisation tools within the scope of the H2020 project ‘EURO-HEALTHY – Shaping EUROpean policies to promote HEALTH equity’. These tools were developed within the working package ‘Decision support for multicriteria modelling of the population health index, foresight and selection of policies’.


Currently, answering to Health Technology Assessment (HTA) challenges from HTA agencies and hospitals, the group has been working upon collaborative, multi-criteria approaches and tools to enable the evaluation of new medicines on a common basis within the scope of the H2020 project IMPACT HTA, by leading ‘WP7 Methodological tools using multicriteria value methods for HTA decision-making’. In parallel, work upon innovative methodologies and tools to consensualise and assess the multidimensional value of Medical Devices are currently being developed with the Portuguese HTA agency (INFARMED) and with three hospitals, within the scope of the FCT project ‘MEDI-VALUE – Developing HTA tools to consensualise MEDIcal devices’ value through multicriteria decision analysis’.


In the context of promoting animal health and welfare, the group has been developing educational tools based upon web-Delphi processes to help educators fostering discussion and critical thinking between graduate and professional students to promote sustainable production systems.) This has been done within the Erasmus+ project ‘ANICARE – Educate animal welfare as a farmer opportunity’.

For information, please contact Mónica Oliveira, details are listed below:

Mónica Oliveira
Associate Professor
Researcher at the Centre for Management Studies of Instituto Superior Técnico
+351 218417322

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