ISSUE: The Japanese government is currently considering to implement an HTA system with MCDA characteristics, this in order to have a transparent HTA system which includes both societal and ethical considerations and to cost effectiveness criteria. Dr Yot presents the case where MCDA delivers a meaningful contribution to the current HTA system from the perspective of government HTA agency, while Dr Igarashi is more careful of MCDA in general and considers the methodology not necessarily suited for pricing decision making for individual technologies in the context of the new HTA in Japan. Dr Ömer Saka provides the industry perspective arguing that MCDA is a tool that manages to include preferences for all relevant stakeholders in a transparent way, while facilitating discussion where the different aspects make decision-making complex. OVERVIEW: Many countries have looked towards MCDA techniques to include qualitative factors in HTA decision making. While MCDA is capable of delivering consistent and transparent results, it remains challenging to implement it successfully. This due to the challenge of determining proper inclusion criteria and determining the weighing of these. Additionally an algorithmic MCDA approach does not allow for much flexibility after the analysis has been completed, while the ethical dilemmas under consideration do require this. Hence, some academics have argued to only use MCDA in a context of an underdeveloped HTA system where a holistic HTA approach is not feasible, where it can provide a transparent decision making system without requiring many resources.