O.R. Applications
The analytic hierarchy process in medical and health care decision making: A literature review

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Abstract

This paper presents a literature review of the application of the analytic hierarchy process (AHP) to important problems in medical and health care decision making. The literature is classified by year of publication, health care category, journal, method of analyzing alternatives, participants, and application type. Very few articles were published prior to 1988 and the level of activity has increased to about three articles per year since 1997. The 50 articles reviewed were classified in seven categories: diagnosis, patient participation, therapy/treatment, organ transplantation, project and technology evaluation and selection, human resource planning, and health care evaluation and policy. The largest number of articles was found in the project and technology evaluation and selection category (14) with substantial activity in patient participation (9), therapy/treatment (8), and health care evaluation and policy (8). The AHP appears to be a promising support tool for shared decision making between patient and doctor, evaluation and selection of therapies and treatments, and the evaluation of health care technologies and policies. We expect that AHP research will continue to be an important component of health care and medical research.

Introduction

The United States continues to devote ever-increasing amounts of its resources to health care. The most recent statistics published by the US government indicate that health care spending was projected to reach $1.7 trillion or 15.3% of its gross domestic product (GDP) in 2003. In addition, this percentage is projected to increase to 18.7% in 10 years (Centers for Medicare and Medicaid Services and US Bureau of the Census, 2004). Total national health expenditures increased by 7.7% in 2003, four times the rate of inflation (Smith et al., 2005). Given the magnitude of these numbers and expenditures, improvement in health care and medical decision making can reap substantial benefits for both patients and health care providers alike. A variety of decision making methods and tools are available to support health care and medical decision making. The purpose of this paper is to review and assess the application of a well-known and widely used decision making methodology, called the analytic hierarchy process (AHP), to important problems in medical and health care decision making.

Section snippets

AHP background

The AHP, developed by Saaty, 1977, Saaty, 1996, is a decision making method for prioritizing alternatives when multiple criteria must be considered. This approach allows the decision maker to structure problems in the form of a hierarchy or a set of integrated levels, such as, the goal, the criteria, and the alternatives. The primary advantage of the AHP is its use of pairwise comparisons to obtain a ratio scale of measurement. Ratio scales are a natural means of comparison among alternatives

Research methodology

To identify those journal articles that describe an application of the AHP in health care and medical decision making, an extensive search was conducted of the literature. The research process included various English language database searches using the AHP keywords “AHP,” “Analytic Hierarchy Process,” “eigenvector,” “eigenvalue,” and “pairwise comparisons.” We searched Pub Med, CINAL (The Cumulative Index to Nursing and Allied Health Literature), and PsycINFO using the AHP keywords. In

Classification

A total of 50 articles that address specific AHP applications were included in this review. Each article was reviewed and classified by year of publication, health care category, journal, method of analyzing alternatives, participants, and application type. Very few articles were published prior to 1988 and the level of activity has increased to about three articles per year since 1997. The articles were classified in seven categories: diagnosis, patient participation, therapy/treatment, organ

Overview

In what follows, we briefly review the articles classified in the medical and health care categories listed in Table 1.

Diagnosis

The AHP has been suggested and applied for use in medical diagnosis. Dolan et al. (1993) used the AHP to determine if endoscopy is overused for low risk patients with acute upper gastrointestinal bleeding. Twenty-five patients and 20 physicians participated in the study. The model consisted of five criteria: identify exact cause of bleeding, avoid test complications, minimize

Discussion and conclusions

Health care and medical decision making has been an early and on-going application area for the AHP, a proven decision-making methodology that has seen widespread applications across numerous fields. This review identifies a substantial body of literature that applies the AHP to health care and medical decision making problems. Since 1997, its application has remained steady, suggesting continued interest in the use of this method.

The AHP appears to be well suited to group decision making

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