Objectives: To discuss the different methods of multi criteria decision analysis (MCDA) that could be used in health technology assessment (HTA) and their relative merits. Methods: The current practice of health technology appraisals is based on the incremental cost-effectiveness ratio (ICER) i.e. the incremental cost per quality adjusted life year (QALY) gained by recipients of treatment. Even though other factors (e.g. severity, life saving, etc) are considered along with ICERs, there is concern that its approach may fail to capture other important sources of value. MCDA is aimed at supporting decision makers faced with evaluating alternatives taking into account multiple, and often conflictive, criteria in an explicit manner. This paper addresses a number of important questions to identify the most appropriate MCDA method that might be used to support decision making. For example, what criteria should be incorporated? Whose weights should be used and how to elicit them? How to incorporate uncertainty into the MCDA process? How do we consider the value of displaced technologies? What should the ‘basic’ cost-effectiveness threshold be? How do we estimate it? This paper will discuss these questions, outline and assess methodological issues that would be raised by the use of MCDA in health technology assessment (HTA). Results: A potential MCDA approach for HTA is to calculate “weighted” QALYs from the QALY weights which reflect the broader value of the product’s benefits and compare against the updated “basic threshold” value. Conclusions: There are general practical issues that might arise from using this MCDA approach in the HTA process and further research needs to be performed to address the issues identified in order to ensure the success of this MCDA technique in the appraisal process.