Practitioners of cost-utility analysis know that their models omit several important factors that often affect real-world decisions about health care options. Furthermore, cost-utility analyses typically reflect only single perspectives (e.g., individual, business, and societal), further limiting the value for those with different perspectives (patients, providers, payers, producers, and planners-the 5Ps). We discuss how models based on multicriteria analyses, which look at problems from many perspectives, can fill this void. Each of the 5Ps can use multicriteria analyses in different ways to aid their decisions. Each perspective may lead to different value measures and outcomes, whereas no single-metric approach (such as cost-utility analysis) can satisfy all these stakeholders. All stakeholders have unique ways to measure value, even if assessing the same health intervention. We illustrate the benefits of this approach by comparing the value of five different hypothetical treatment choices for five hypothetical patients with cancer, each with different preference structures. Nine attributes describe each treatment option. We add a brief discussion regarding the use of these approaches in group-based decisions. We urge that methods to value health interventions embrace the multicriteria approaches that we discuss, because these approaches 1) increase transparency about the decision process, 2) allow flight simulator-type evaluation of alternative interventions before actual investment or deployment, 3) help focus efforts to improve data in an efficient manner, 4) at least in some cases help facilitate decision convergence among stakeholders with differing perspectives, and 5) help avoid potential cognitive errors known to impair intuitive judgments.

No abstract

As the mechanisms for discovery, development, and delivery of new vaccines become increasingly complex, strategic planning and priority setting have become ever more crucial. Traditional single value metrics such as disease burden or cost-effectiveness no longer suffice to rank vaccine candidates for development. The Institute of Medicine—in collaboration with the National Academy of Engineering—has developed a novel software system to support vaccine prioritization efforts. The Strategic Multi-Attribute Ranking Tool for Vaccines—SMART Vaccines—allows decision makers to specify their own value structure, selecting from among 28 pre-defined and up to 7 user-defined attributes relevant to the ranking of vaccine candidates. Widespread use of SMART Vaccines will require compilation of a comprehensive data repository for numerous relevant populations—including their demographics, disease burdens and associated treatment costs, as well as characterizing performance features of potential or existing vaccines that might be created, improved, or deployed. While the software contains preloaded data for a modest number of populations, a large gap exists between the existing data and a comprehensive data repository necessary to make full use of SMART Vaccines. While some of these data exist in disparate sources and forms, constructing a data repository will require much new coordination and focus. Finding strategies to bridge the gap to a comprehensive data repository remains the most important task in bringing SMART Vaccines to full fruition, and to support strategic vaccine prioritization efforts in general.

Evolutionary science has led to many practical applications of genetic evolution but few practical uses of cultural evolution. This is because the entire study of evolution was gene centric for most of the 20th century, relegating the study and application of human cultural change to other disciplines. The formal study of human cultural evolution began in the 1970s and has matured to the point of deriving practical applications. We provide an overview of these developments and examples for the topic areas of complex systems science and engineering, economics and business, mental health and well-being, and global change efforts.