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Eliciting priors to characterize uncertainties in decision analytic models
Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
Centre for Health Economics, University of York, York, United Kingdom.
Health Economics Department, AstraZeneca, Södertälje, Sweden.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Expert opinions are often used in decision models when evidence is scarce. This study describes the details of a formal elicitation exercise to estimate parameter values and their associated uncertainty and compares the results in term of cost-effectiveness and value of information with results from only eliciting mean values from experts.

Methods: Elicited distributions for 11 unknown parameters where incorporated into a previously developed cost-effectiveness model for prosthetic knees for amputees. The original model included elicited mean values for the missing values, thus ignoring any uncertainty across experts’ beliefs.

Results: The incremental cost-effective ratio (ICER) for the analysis based on the current elicited distributions was substantially higher (€13 625) than the ICER in the original analysis (€3 258). Even decision uncertainty, at a €35 000 threshold, increased significantly, increasing the value of further research from €355 100 in the original analysis, to €5 987 444 for the current elicited values.

Conclusions: Failing to account for the individual expert’s uncertainty might have a considerable impact on the result of cost-effectiveness analyses. Formal expert elicitation offers a plausible method to generate prior distributions representing the experts’ uncertainty and thereby more appropriately account for the true uncertainty of the decision.

National Category
Economics and Business
URN: urn:nbn:se:liu:diva-56593OAI: diva2:320603
Available from: 2010-05-26 Created: 2010-05-26 Last updated: 2010-05-26
In thesis
1. Cost-effectiveness analysis of health technologies when evidence is scarce
Open this publication in new window or tab >>Cost-effectiveness analysis of health technologies when evidence is scarce
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Given the increasing pressures on health care budgets, economic evaluation is used in many countries to assist decision-making regarding the optimal use of competing health care technologies. Although the standard methods of estimating cost-effectiveness underpinning these decisions have gained widespread acceptance, concerns have been raised that many technologies would not be considered for funding, due to scarcity of evidence. However, as long as the amount and quality of evidence used for the analysis are properly characterized, scarce evidence per se should not be seen as a hindrance to perform cost-effectiveness analyses. Characterizing uncertainty appropriately, though, may pose a challenge even when there is a large body of evidence available, and even more so when evidence is scarce. The aims of this thesis are to apply a methodological framework of cost-effectiveness analysis and explore methods for characterising uncertainty when evidence is scarce. Three case studies associated with limited evidence provide economic evaluations on current decision problems, investigate the feasibility of using the framework, and explore methods for characterizing uncertainty when evidence is scarce.

The results of the case studies showed that, given current information, providing transfemoral amputees with C-Leg and Airsonett Airshower to patients with perennial allergic asthma could be considered cost-effective whereas screening for hyperthrophic cardiomyopathy among young athletes is unlikely to be cost-effective. In the cases of C-Leg and Airsonett Airshower conducting further research is likely to be cost-effective. The case studies indicate that it is feasible to apply methods of cost-effectiveness in health care for technologies not commonly evaluated due to lack of evidence. The analysis showed that failing to account for individual experts’ might have a substantial effect on the interpretation of the results of cost-effectiveness analysis. Formal expert elicitation is a promising method of characterizing uncertainty when evidence is missing, and thus enable cost-effectiveness and value of further research to be appropriately estimated in such situations.

In conclusion, this thesis shows that scarcity of evidence should not preclude the use of cost-effectiveness analysis. On the contrary, in such cases it is probably more important than ever to use a framework that enable us to define key parameters for a decision problem and identify available evidence in order to determine cost-effectiveness given current information and provide guidance on further data collection.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 41 p.
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1324
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
urn:nbn:se:liu:diva-56595 (URN)978-91-7393-363-6 (ISBN)
Public defence
2010-06-18, Aulan i Hälsans hus, Campus US, Linköpings universitet, Linköping, 09:00 (English)
In the list of included articles in the Ph.D. thesis the title of manuscript IV is "Cost-effectiveness of screening for hypertrophic cardiomyopathy in young athletes" but the title of the included article in the Ph.D. thesis is "Screening for hypertrophic cardiomyopathy in young athletes: A cost-effectiveness analysis".Available from: 2010-05-26 Created: 2010-05-26 Last updated: 2010-05-26Bibliographically approved

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