Using a Fuzzy Approach in Multi-Criteria Decision Making with Multiple Alternatives in Health Care

One of the responsibilities of the health care sector regulator is to decide which health technologies (drugs, procedures, diagnostic tests, etc.) should be financed using public resources. That requires taking into account multiple criteria, of which two important ones are: cost and effectiveness of a technology (others being, e.g., prevalence, safety, ethical and social implications). Hence, health and wealth need to be traded off against each other, and hence the willingness-to-pay (WTP) has to be determined. Various approaches to setting WTP have been taken, yet the results differ substantially. In the present paper I claim that the proper approach is to treat WTP as a fuzzy concept (the decision maker may not be able to decidedly state that a given health-wealth trade-off coefficient is acceptable/unacceptable - an idea backed up by the survey presented in the paper). Previous research shows how this fuzzy approach can be embedded in defining the preference relation and pairwise comparisons. In the present paper I account for the fact that there are often more than two alternatives available. To avoid difficulties that might arise (e.g., incompleteness or intransitivity of preferences) I show how the fuzzy approach can be used to define a fuzzy choice function based on the axiomatic approach. Some properties are discussed (e.g., how the approach handles the dominance and extended dominance), and the directions of further research are hinted at.