Results We propose a methodological process comprising five distinct phases (problem structuring, model building, model assessment, model appraisal and development of action plans), outline the stages involved in each phase and discuss their relevance in the HTA process. Additionally, criteria and attributes need to satisfy a set of desired properties, otherwise the process of preference elicitation can produce spurious results. The resulting MCDA output, which can take the form of a single universal value index, can be informed by stakeholder participation and therefore can be robust and reflective of stakeholder preferences.