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In the past decade, the use of multiple-criteria decision analysis technology has dramatically increased in solving complex real-world problems in solid waste management. Likewise, many municipalities have paid attention to finding feasible solutions for disposal and recycling of solid waste due to the increase in waste generation rates worldwide. Therefore, policy-makers must determine which recycling program to be implemented among various recycling program options. In this paper, a new approach to select a recycling program for recovered paper and pulp recyclables was proposed using analytic hierarchy process–Technique for Order Preference by Similarity to Ideal Solution (AHP-TOPSIS) techniques. A set of essential parameters of the decision-making system were identified, and a numerical case to illustrate the procedure was conducted. Our findings show very encouraging results to use a combined model between AHP and TOPSIS to select a suitable recycling program for different recovered recyclable materials.

Our society is facing serious environmental challenges related to climate change, pollution, diminishing resources, and biodiversity loss. Such problems are often ill-defined and are characterized by high uncertainty. Environmental decisions have strong impacts on society and demand clear and transparent trade-offs across values and priorities of stakeholder groups. This Feature Issue on Environmental Decisions includes papers focused on important environmental applications approached through various disciplinary backgrounds. The papers highlight advanced–often interdisciplinary–methodological approaches and include the perspectives of different stakeholders in the process of environmental decision-making. A wide range of methods are explored, ranging from a comprehensive review (for sustainable transport by Marleau Donais et al.) to an opinion paper proposing the use of Records of Engagement and Decision-making (RoED; by Cockerill et al.). Stakeholder engagement and preference elicitation required the development of new aggregation models for Multi-Criteria Decision Analysis (MCDA; by Reichert et al.). The integration of Cost-Benefit Analysis (CBA) with MCDA was found to be necessary in practice (by Liu et al.; Marleau Donais et al.). MCDA was extended to include the spatial dimension by integrating Geographic Information Systems (GIS; by Guay et al.; Schito et al.). The importance of considering the resilience of systems to better respond to and recover from unpredictable risks was emphasized (by Leyerer et al.; Mustajoki and Marttunen). These papers demonstrate the richness of approaches to environmental decision-making. Environmental issues offer ample exciting research opportunities to a broader scientific community. We encourage the readers of this Feature Issue—and of EJDP—to engage in environmental decision-making projects to support emerging societal needs.

Objectives The objective of the study was to identify the critical factors that determine recommendations and other decisions about healthcare-related tests and diagnostic strategies (HCTDS). Methods We used a qualitative descriptive approach and conducted semi-structured in-depth interviews with 24 international experts (informants) in evidence and decisions about HCTDS. Results Although test accuracy (TA) was the factor most commonly considered by organizations when developing recommendations about HCTDS, informants agreed that TA is necessary but rarely, if ever, sufficient and may be misleading when solely considered. The informants identified factors that are important for developing recommendations about HCTDS. Informants largely agreed that laying out the potential care pathways based on the test result is an essential early step but is rarely done in developing recommendations about HCTDS. Most informants also agreed that decision analysis could be useful for organizing the clinical, cost, and preference data relevant to the use of tests in the absence of direct evidence. However, they noted that using models is limited by the lack of resources and expertise required. Conclusion Developing guidelines about HCTDS requires consideration of factors beyond TA, but implementing this may be challenging. Further development and testing of “frameworks” that can guide this process is a priority for decision makers.

Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology is used to assess and report certainty of evidence and strength of recommendations. This GRADE concept article is not GRADE guidance but introduces certainty of net benefit, defined as the certainty that the balance between desirable and undesirable health effects is favourable. Determining certainty of net benefit requires considering certainty of effect estimates, the expected importance of outcomes and variability in importance, and the interaction of these concepts. Certainty of net harm is the certainty that the net effect is unfavourable. Guideline panels using or testing this approach might limit strong recommendations to actions with a high certainty of net benefit or against actions with a moderate or high certainty of net harm. Recommendations may differ in direction or strength from that suggested by the certainty of net benefit or harm when influenced by cost, equity, acceptability or feasibility.

Background Navigating treatment pathways remains a challenge for populations with complex needs due to bottlenecks, service gaps and access barriers. The application of novel methods may be required to identify and remedy such problems. Objective To demonstrate a novel approach to identifying persistent service gaps, generating potential solutions and prioritizing action. Design Co‐creation and multi‐criteria decision analysis in the context of a larger, mixed methods study. Setting and participants Community‐dwelling sample of older women living alone (OWLA), residing in Melbourne, Australia (n = 13‐37). Convenience sample of (n = 11) representatives from providers and patient organizations. Interventions Novel interventions co‐created to support health, well‐being and independence for OWLA and bridge missing links in pathways to care. Main outcome measures Performance criteria, criterion weights , performance ratings, summary scores and ranks reflecting the relative value of interventions to OWLA. Results The co‐creation process generated a list of ten interventions. Both OWLA and stakeholders considered a broad range of criteria when evaluating the relative merits of these ten interventions and a “Do Nothing” alternative. Combining criterion weights with performance ratings yielded a consistent set of high priority interventions, with “Handy Help,” “Volunteer Drivers” and “Exercise Buddies” most highly ranked by both OWLA and stakeholder samples. Discussion and conclusions The present study described and demonstrated the use of multi‐criteria decision analysis to prioritize a set of novel interventions generated via a co‐creation process. Application of this approach can add community voice to the policy debate and begin to bridge the gap in service provision for underserved populations.

Background The threshold model represents one of the most significant advances in the field of medical decision‐making, yet it often does not apply to the most common class of clinical problems, which include health outcomes as a part of definition of disease. In addition, the original threshold model did not take a decision‐maker's values and preferences explicitly into account. Methods We reformulated the threshold model by (1) applying it to those clinical scenarios, which define disease according to outcomes that treatment is designed to affect, (2) taking into account a decision‐maker's values. Results We showed that when outcomes (eg, morbidity) are integral part of definition of disease, the classic threshold model does not apply (as this leads to double counting of outcomes in the probabilities and utilities branches of the model). To avoid double counting, the model can be appropriately analysed by assuming diagnosis is certain (P = 1). This results in deriving a different threshold—the threshold for outcome of disease (M t ) instead of threshold for probability of disease (P t ) above which benefits of treatment outweigh its harms. We found that M t ≤ P t, which may explain differences between normative models and actual behaviour in practice. When a decision‐maker values outcomes related to benefit and harms differently, the new threshold model generates decision thresholds that could be descriptively more accurate. Conclusions Calculation of the threshold depends on careful disease versus utility definitions and a decision‐maker's values and preferences.

Objective: To advance the development of an ideal and sustainable framework agreement for the public procurement of vaccines in Spain, and to agree on the desirable award criteria and their relative weight. Methods: A multidisciplinary committee of seven health-care professionals and managers developed a partial multi-criteria decision analysis to determine the award criteria that should be considered and their specific weights for the public procurement of routine vaccines and seasonal influenza vaccines, considering their legal viability. A re-test of the results was carried out. The current situation was analyzed through 118 tender specifications and compared to the ideal framework. Results: Price is the prevailing award criterion for the public procurement of both routine (weighting of 60% versus 40% for all other criteria) and influenza (36% versus 64%) vaccines. Ideally, 22 criteria should be considered for routine vaccines, grouped and weighted into five domains: efficacy (weighting of 29%), economic aspects (27%), vaccine characteristics (22%), presentation form and packaging (13%), and others (9%). Per criteria set, price was the most important criterion (22%), followed by effectiveness (9%), and composition/formulation (7%). Regarding influenza vaccines, 20 criteria were selected, grouped, and weighted: efficacy (29%), economic aspects (25%), vaccine characteristics (20%), presentation form and packaging (16%), and others (11%). Per criteria set, price was also the most relevant criterion (19%), followed by composition/formulation (8%), and effectiveness (8%). Conclusions: Contrary to the current approach, technical award criteria should prevail over economic criteria in an ideal and sustainable framework agreement for the public procurement of vaccines.