title: Applying the Analytic Hierarchy Process in healthcare research: A systematic literature review and evaluation of reporting.
abstract: BACKGROUND
  The Analytic Hierarchy Process (AHP), developed by Saaty in the late 1970s, is one of the methods for multi-criteria decision making. The AHP disaggregates a complex decision problem into different hierarchical levels. The weight for each criterion and alternative are judged in pairwise comparisons and priorities are calculated by the Eigenvector method. The slowly increasing application of the AHP was the motivation for this study to explore the current state of its methodology in the healthcare context.
  
  
  METHODS
  A systematic literature review was conducted by searching the Pubmed and Web of Science databases for articles with the following keywords in their titles or abstracts: "Analytic Hierarchy Process," "Analytical Hierarchy Process," "multi-criteria decision analysis," "multiple criteria decision," "stated preference," and "pairwise comparison." In addition, we developed reporting criteria to indicate whether the authors reported important aspects and evaluated the resulting studies' reporting.
  
  
  RESULTS
  The systematic review resulted in 121 articles. The number of studies applying AHP has increased since 2005. Most studies were from Asia (almost 30%), followed by the US (25.6%). On average, the studies used 19.64 criteria throughout their hierarchical levels. Furthermore, we restricted a detailed analysis to those articles published within the last 5 years (n = 69). The mean of participants in these studies were 109, whereas we identified major differences in how the surveys were conducted. The evaluation of reporting showed that the mean of reported elements was about 6.75 out of 10. Thus, 12 out of 69 studies reported less than half of the criteria.
  
  
  CONCLUSIONS
  The AHP has been applied inconsistently in healthcare research. A minority of studies described all the relevant aspects. Thus, the statements in this review may be biased, as they are restricted to the information available in the papers. Hence, further research is required to discover who should be interviewed and how, how inconsistent answers should be dealt with, and how the outcome and stability of the results should be presented. In addition, we need new insights to determine which target group can best handle the challenges of the AHP.
authors.affiliation: Center for Health Economics Research Hannover (CHERH), Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany. ks@cherh.de.
authors.forename: Katharina
authors.initials: K
authors.lastname: Schmidt
authors.affiliation: Center for Health Economics Research Hannover (CHERH), Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany. ia@cherh.de.
authors.forename: Ines
authors.initials: I
authors.lastname: Aumann
authors.affiliation: Institute for Risk and Insurance, Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany. ines.hollander@gmail.com.
authors.forename: Ines
authors.initials: I
authors.lastname: Hollander
authors.affiliation: Center for Health Economics Research Hannover (CHERH), Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany. kd@cherh.de.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Damm
authors.affiliation: Center for Health Economics Research Hannover (CHERH), Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany. jms@cherh.de.
authors.forename: J-Matthias Graf
authors.initials: JM
authors.lastname: von der Schulenburg
mesh_terms: D003657:Decision Making; D006302:Health Services Research / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans