The framework

A pragmatic and reflective decisionmaking and priority setting framework

  • Designed to support thorough, balanced, accountable and reasonable healthcare decisionmaking
  • Based on ethical aspects underpinning health care decision making
  • Designed to tackle ethical dilemmas of the triple aim of healthcare
  • Includes quantitative and qualitative components
  • Reflective scales to assess the meaning of evidence
  • A comprehensive tool including conceptual background, evidence-based methodology, and ready-to-use tools easily adaptable to any context and level of decision
  • Open source, continuously updated based on multicountry and multidisciplinary research and real-world applications



A series of tools and processes constitute the MCDA-based EVIDEM framework, which is designed to holistically integrate the ethical positions underpinning healthcare decisionmaking via operationalizable criteria while providing an accountable and reflective process to support decisionmaking. Some tools are translated in several languages including: العربية, Deutsch, English, Español, Français, Italiano, Nederlands, Português, Română, Pусский, 中国 (Zhōngguó);

The goal of the EVIDEM framework is to support appraisal of the value of healthcare interventions from a holistic perspective and optimize their prioritization. In line with an open source philosophy, its tools are regularly updated based on feedback from active members of the collaboration.

The EVIDEM framework is based on an analysis of ethical underpinnings, analyses and feedback on decision criteria in use worldwide, MCDA research and the most current developments in the field. The processes proposed are meant to support the thinking process underlying appraisal/prioritization of healthcare interventions, with a holistic consideration of normative (i.e., what should we do) and feasibility (what can be done) aspects. The framework includes an MCDA Core Model based on universal principles and a Contextual Tool to adapt the framework to specific contexts and end-users needs.

Framework tools and processes are readily available to members, including:

  • Decision Criteria – conceptual background, definitions, and instructions: conceptual approach, definitions, sub-criteria, and instructions for use of each criterion and overall framework;
  • Multicriteria Value Assessment Package: combined MCDA Core Model & Contextual Tool to perform appraisal of healthcare interventions;
  • Multicriteria HTA Report– Instrument for Synthesizing Evidence: process and instructions to synthesize evidence for each decision criterion;
  • Multicriteria HTA Report – Instrument for Assessing Quality of Evidence: instruments for standardized critical analyses of studies (epidemiology; clinical, effectiveness and PRO; economic evaluations and budget impact);
  • MCDA Weight Elicitation Techniques: instruments to perform six different types of weight elicitation;
  • MCDA Core Model software: data analysis & graphical presentation of value appraisal;
  • Multicriteria Research Question Prioritization Package: ready-to-use package to prioritize comparative effectiveness research questions;
  • Multicriteria Research Question Prioritization software: data analysis & graphical presentation of prioritization of research questions