OBJECTIVES: This paper will discuss the different methods of multi criteria decision analysis (MCDA) that could be used in health technology assessment (HTA) and their relative merits.Description: 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. METHODS: MCDA is aimed at supporting decision makers faced with evaluating alternatives taking into account multiple, and often conflictive, criteria in an explicit manner. An overview of MCDA is provided and is compared against the current health technology appraisal processes. A number of important questions are addressed 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: Most of the proposed MCDA approaches in literature use the same technique (weighted sum approach), however, more flexible approaches are available that are relevant to health technology appraisal and value based pricing (VBP). 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.