Improving Priority-Setting for Appropriate Health Technologies: An MCDA-Based Framework and Real-World Pilot in China

Aim: This thesis investigates how multi-criteria decision analysis (MCDA) can be integrated to improve the priority-setting process for the selection of Appropriate Health Technology (AHT) in China, with a focus on supporting the National Appropriate Health Technology List (NAHTL) and a related pilot program.
Background: Systematic priority-setting remains underdeveloped in China’s AHT programmes, with challenges including unclear definitions, inconsistent criteria, and limited structure for trade-offs and uncertainty. MCDA offers a transparent and consistent approach for complex health decisions.
Methods: A mixed-methods design was adopted, including systematic and narrative reviews, a case study, stakeholder interviews, and an applied pilot. Key components were: (1) a systematic review of global HTA topic selection practices; (2) a narrative review of international appraisal frameworks; (3) a case study of current NAHTL practices; (4) a systematic review of provincial AHT selection; (5) stakeholder interviews to refine the AHT definition and criteria; (6) development of a refined conceptual framework (CF) and process guide using MCDA principles; and (7) a real-world pilot applying the CF to AI-assisted health technologies in Beijing.
Results: Findings showed substantial variation in international priority-setting practices and highlighted procedural weaknesses in the NAHTL process. Local evidence and interview insights emphasised the need to clarify AHT definitions, separate costs from benefits, and integrate value-for-money and uncertainty handling. The refined CF addresses these gaps by defining the object of selection, establishing appropriate criteria, and structuring trade-offs. The pilot confirmed feasibility and acceptability while noting practical challenges such as time and familiarity.
Conclusions: An MCDA-informed framework can improve the consistency, transparency, and evidence base of AHT priority-setting in China. The CF and process guide provide practical tools for institutionalising better decision-making and may offer insights to other low- and middle-income countries (LMICs) for strengthening HTA under resource constraints.