As mentioned in the beginning of this section, EE is an important but not sufficient dimension of
decision-making regarding the provision or funding of new technologies. In recent years, many jurisdictions
have been challenged with the need to expand the four traditional criteria. Some additional
criteria proposed include patient preferences, social and ethical values. Until now, the full
incorporation of these criteria into existing decision-making processes is in early stages. In this regard,
there has been a growing interest into alternative decision-making frameworks, among which
multicriteria decision analysis (MCDA) has obtained particular attention. MCDA is both a process and
set of methods that explicitly and simultaneously take into consideration multiple decision-making
attributes that may conflict to a certain extent [36]. Some jurisdictions, including Canada [37], the
United Kingdom [38], and Germany [39] have explored the formal use of this type of decision-making
framework. However, research into alternative decision-making frameworks, using EE among other
dimensions, is still in its infancy and more work in this area is needed to fully inform decision-making
in health care.