Portfolio decision analysis for population health

In this chapter, we discuss the application of Multi-Criteria Portfolio Decision Analysis in healthcare. We consider the problem of allocating a limited budget to healthcare for a defined population, where the healthcare planner needs to take into account both the state of ill-health of the population, and the costs and benefits of providing different healthcare interventions. To date, two techniques have been applied widely to combine these two perspectives: Generalized Cost Effectiveness Analysis and Program Budgeting and Marginal Analysis. We describe these two approaches and present a case study to illustrate how a simple, formal Multi-Criteria Portfolio Decision Analysis model can help structure this sort of resource allocation problem. The case study highlights challenges for the research community around the use of disease models, capturing preferences relating to health inequalities, unrelated future costs, the appropriate balance between acute and preventive interventions, and the quality of death