OBJECTIVES: To test and further develop a decision support framework (EVIDEM) using growth hormone (GH) for Turner syndrome (TS) as a complex case study. METHODS: The MCDA matrix included 15 quantifiable components of decision clustered in four domains (quality of evidence, disease, intervention and economics). Six non-quantifiable components of decision were identified and organized into a tool using an ethical framework. A synthesized health technology assessment (HTA) report on GH for TS tailored to each component of decision was prepared and validated by experts. A panel of representative stakeholders estimated the MCDA value of GH for TS in Canada by assigning weights and scores. Impact of non-quantifiable components of decision was also considered. Validity of approach was explored. RESULTS: The HTA report revealed data needs for decisionmaking in particular regarding patient reported outcomes. Panelists estimated the value of GH for TS at 41% (min: 26%, max: 54%) of maximum value on the MCDA scale. Retest value estimate was 40% with high intra-rater agreement. Main contributors to value estimate were quality of evidence, disease severity, improvement of clinical and patient reported outcomes compared to no treatment. Significant expenditures associated with GH contributed little to value. Ethical considerations had mixed effects on value of GH. On average, 71% of panelists indicated that the same 13 quantifiable and 4 non-quantifiable components should always be considered. CONCLUSIONS: The framework allows transparent consideration of all components of decision and underlying evidence. Further testing and validation is needed to further develop MCDA approaches in healthcare decisionmaking.