Table 2.

Review of challenges associated with approaches to integrating social justice concerns into economic evaluation

Challenge	‘Direct’ approaches	‘Indirect’ approaches
Clarifying the normative basis	Requires consensus; Criteria must be exhaustive, assessable, and mutually exclusive criteria, and reflective of the acceptable theoretical framework
Measuring selected criteria	Criteria must be numerical; expected standards are similar to those for standard economic evaluation data	Depending on type of comparison, criteria can be descriptive, binary, ordinal, or numerical
Determining relative importance of criteria	Relative importance must be expressed algebraically a priori to analysis	For qualitative and mixed MCDA, the determination of relative importance is delayed and can be implicit For quantitative MCDA, relative importance must be expressed algebraically a priori to appraisal
Combining criteria	Operational challenges in computation and concern about potential interaction	Concern about potential interaction
Evaluating trade-offs	Guidance must be explicitly expressed in cost-effectiveness units	For qualitative and mixed MCDA, tradeoffs require value judgment For quantitative MCDA, guidance must be explicitly expressed in units of all criteria

MCDA: Multicriteria decision analysis