A multi-criteria
decision analysis
as an innovative
approach
to managing Lyme
disease
May 29th, 2014
Cécile Aenishaenslin, Valérie Hongoh, Hassane Djibrilla
Cissé, Anne Gatewood Hoen, Karim Samoura, Pascal Michel,
Jean-Philippe Waaub, Denise Bélanger
Background
Complex ecology
What public health
actions are the most
appropriate in Quebec?
Lyme disease Emergence
in Québec
2004: 2 cases
2013: near 140 cases
Environmental
Social
Economic
2
2
Research
Plan objectives
1. To prioritize potential Lyme disease
management actions using a multicriteria
decision analysis (MCDA)
2. To evaluate the opportunities and challenges
associated with the use of MCDA for public
health planning
3
3
Methods
Plan
Rank
alternatives
Multiple
decision
criteria
Complexity
MCDA
Participatory
approach
Quantitative &
qualitative
4
4
Methods
Plan
1. Define the problem
2. Identify stakeholders
3. Identify important issues
4. Define criteria and indicators
Problem
structuring
5. Identify alternatives
6. Evaluate performance of alternatives
7. Weight criteria
8. Conduct decision analysis
9. Perform sensitivity analysis
Decision analysis
10. Interpret the results
5
5
Results
Plan
What public health actions should be prioritized in a context of
LD emergence in the province of Quebec?
•
•
•
•
•
•
Québec National Institute of Public Health
National Public Health Laboratory
Ministry of Agriculture, Fisheries and Food
Ministry of Natural Resources and Wildlife
Montérégie Regional Board of Health and Social
Services
Academic Expert
1- What surveillance actions are the most appropriate?
2- What control actions are the most appropriate?
6
6
Public health
Plan
•PHC1 Reduction in incidence of human cases
•PHC2 Reduction in entomological risk
•PHC3 Impacts of adverse health effects
Animal and environmental health
•AEC1 Impact on habitat
•AEC2 Impact on wildlife
Social impact
•SIC1 Level of public acceptance
•SIC2 Proportion of population benefitting from
intervention
Strategic, economic and operational impact
•SEC1 Cost to the public sector
•SEC2 Cost to the private sector
(1) days; (2) weeks;
•SEC3 Delay before results
(3) months; (4) years
•SEC4 Complexity
•SEC5 Impact on organisation’s credibility
7
7
Results
Plan
Inclusion of control actions
oriented toward:
• Environment
• Vector hosts
• Human populations
Performance matrix
CONT0 Basic risk communications
CONT1a Small scale acaricide application
CONT1b Large scale acaricide application
CONT2 Application of insecticidal soap
CONT3a Small scale Landscaping
CONT3b Large scale Landscaping
CONT4 Topical acaricide to deer (4-poster)
CONT5 Feed-administered ivermectin to deer
CONT6a Deer hunting
CONT6b Deer culling
CONT7 Exclusion of deer by fencing
CONT8 Topical acaricide to rodents (Damminix)
CONT9 Topical acaricide to rodents (Bait boxes)
CONT10 Excluding people from high-risk public areas
CONT11 Human vaccination
8
CONT12 Making available special Lyme disease clinics
8
Results
Plan
Individual weighting of each
criteria
Stakeholders weights for
each category of criteria
Public health
Animal and environmental
Social impacts
Strategic & operationnal
Results
Plan
Performance matrix
Group
ranking
Stakeholders weights
Action
profiles
Results
Plan
Group ranking of actions
Actions
CONT0
CONT11
CONT3a
CONT10
CONT12
CONT4
CONT7
CONT1a
CONT3b
CONT1b
CONT2
CONT5
CONT8
CONT9
CONT6a
CONT6b
Basic risk communications
Human vaccination
Small scale landscaping
Excluding people from high-risk public areas
Making available special Lyme disease clinics
Topical acaricide to deer (4-poster)
Exclusion of deer by fencing
Small scale acaricide application
Large scale Landscaping
Large scale acaricide application
Application of desiccants
Feed-administered ivermectin to deer
Topical acaricide to rodents (Damminix)
Topical acaricide to rodents (Bait boxes)
Deer hunting
Deer culling
Rank
Score
1
2
3
4
5
6
7
7
8
9
10
11
12
12
13
14
0.43
0.31
0.28
0.25
0.23
0.03
-0.04
-0.04
-0.07
-0.08
-0.14
-0.15
-0.22
-0.22
-0.25
-0.33
Results
Plan
Actions profiles
Small scale landscaping
Human vaccination
Public health
Animal and environmental
Social impacts
Strategic
& operationnal
Aenishaenslin et al.,2013. Multi-criteria decision analysis
as an innovative approach to managing
zoonoses: results from a study on Lyme disease in Canada. BMC Public Health, 13:897.
12
MCDA
Plan strengths
One
Health
Multiple decision
criteria
Knowledge
gaps
MCDA
Institutional
empowerment
Rank
alternatives
Quantitative &
qualitative
Complexity
Participatory
approach
13
Key
Planmessages
• MCDA is an interesting tool to support
‘Evidence-based public health’ for complex
public health issues
• Each MCDA step produces a valuable
result
• The model could be generalized for other
VB/zoonosic disease
14
Merci!
PlanThank you!
Thanks to all stakeholders and experts
and the Lyme-MCDA Consortium:
Nathalie Côté
Annie Doucet
Cécile Ferrouillet
Anne Fortin
Francis Girard
Pierre Gosselin
François Milord
Louise Trudel
Nick Ogden
Patrick Leighton
Jules Koffi
Catherine Bouchard
Anne-Laure Bouvier
The realization of this project
was made possible by financial
contribution of the Public
Health Agency of Canada
(PHAC). The sights expressed
here do not reflect the official
position of the PHAC.
15
Results
Plan
16
Additional
slide
Plan
Lyme disease cases in Canada,
1994-2012
Ogden et al., 2014
Lyme disease cases in Québec,
2004-2013
Direction de la santé publique de la
Montérégie, 2013
17
17
Additional
slide
Plan
Action
PHC1
PHC2
CONT0
CONT1a
CONT1b
CONT2
CONT3a
CONT3b
CONT4
CONT5
CONT6a
CONT6b
CONT7
CONT8
CONT9
CONT10
CONT11
CONT12
1
2
2
1
2
2
2
1
0
1
1
0
0
1
2
0
0
3
3
2
3
3
3
2
2
2
2
1
1
0
0
0
PHC3 AEC1 AEC2
0
2
2
2
1
2
2
2
2
2
0
2
2
0
2
0
1
16
48
24
20
30
3
3
3
3
12
3
3
3
1
1
1
8
18
8
4
9
12
12
18
27
6
8
8
1
1
1
SIC1
3
2
2
2
3
2
3
3
2
1
3
3
3
3
3
4
SIC2 SEC1 SEC2 SEC3 SEC4 SEC5
4
1
4
1
1
1
1
1
2
2
1
1
1
3
3
3
1
1
2
1
1
1
2
1
0
2
2
2
2
0
1
1
0
1
0
0
0
0
1
1
0
0
2
1
1
0
0
0
3
2
2
2
2
2
4
4
4
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3
3
2
2
2
1
4
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5
1
3
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2
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4
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3
2
2
Additional
slide
Plan
GAIA decision map under the emergence scenario
19