Wolff HB, Qendri V, Kunst N, Alarid-Escudero F, Coupé VMH. Methods for Communicating the Impact of Parameter Uncertainty in a Multiple-Strategies Cost-Effectiveness Comparison.
Med Decis Making 2022;
42:956-968. [PMID:
35587181 PMCID:
PMC9452448 DOI:
10.1177/0272989x221100112]
[Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose
Analyzing and communicating uncertainty is essential in medical decision
making. To judge whether risks are acceptable, policy makers require
information on the expected outcomes but also on the uncertainty and
potential losses related to the chosen strategy. We aimed to compare methods
used to represent the impact of uncertainty in decision problems involving
many strategies, enhance existing methods, and provide an open-source and
easy-to-use tool.
Methods
We conducted a systematic literature search to identify methods used to
represent the impact of uncertainty in cost-effectiveness analyses comparing
multiple strategies. We applied the identified methods to probabilistic
sensitivity analysis outputs of 3 published decision-analytic models
comparing multiple strategies. Subsequently, we compared the following
characteristics: type of information conveyed, use of a fixed or flexible
willingness-to-pay threshold, output interpretability, and the graphical
discriminatory ability. We further proposed adjustments and integration of
methods to overcome identified limitations of existing methods.
Results
The literature search resulted in the selection of 9 methods. The 3 methods
with the most favorable characteristics to compare many strategies were 1)
the cost-effectiveness acceptability curve (CEAC) and cost-effectiveness
acceptability frontier (CEAF), 2) the expected loss curve (ELC), and 3) the
incremental benefit curve (IBC). The information required to assess
confidence in a decision often includes the average loss and the probability
of cost-effectiveness associated with each strategy. Therefore, we proposed
the integration of information presented in an ELC and CEAC into a single
heat map.
Conclusions
This article presents an overview of methods presenting uncertainty in
multiple-strategy cost-effectiveness analyses, with their strengths and
shortcomings. We proposed a heat map as an alternative method that
integrates all relevant information required for health policy and medical
decision making.
Highlights
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