English, Article edition: Incorporation of Uncertainty in Health Economic Modelling Studies Anthony O'Hagan; Christopher McCabe; Ron Akehurst; ...

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Physical Description
  • article
Language
  • English

Edition details

Title
  • Incorporation of Uncertainty in Health Economic Modelling Studies
Author
  • Anthony O'Hagan
  • Christopher McCabe
  • Ron Akehurst
  • Alan Brennan
  • Andrew Briggs
  • Karl Claxton
  • Elisabeth Fenwick
  • Dennis Fryback
  • Mark Sculpher
  • David Spiegelhalter
  • Andrew Willan
Physical Description
  • article
Notes
  • In a recent leading article in PharmacoEconomics, Nuijten described some methods for incorporating uncertainty into health economic models and for utilising the information on uncertainty regarding the cost effectiveness of a therapy in resource allocation decision-making. His proposals are found to suffer from serious flaws in statistical and health economic reasoning. Nuijten's suggestions for incorporating uncertainty: (a) wrongly interpret the p-value as the probability that the null hypothesis is true; (b) represent this probability wrongly by truncating the input distribution; and (c) in the specific example of an antiparkinsonian drug uses a completely inappropriate p-value of 0.05 when the null hypothesis would, in reality, be emphatically disproved by the data. His suggestions regarding minimum important differences in cost effectiveness: (a) introduce areas of indifference that suggest inappropriate reliance on cost minimisation while failing to recognise that decisions should be based on expected costs versus benefits; and (b) offer no guidance on how the probabilities associated with these areas could be used in decision-making. Furthermore, Nuijten's model for Parkinson's disease is over-simplified to the point of providing a bad example of modelling practice, which may mislead the readers of PharmacoEconomics. The rationale for this paper is to ensure that readers do not apply inappropriate analyses as a result of following the proposals contained in Nuijten's paper. In addition to a detailed critique of Nuijten's proposals, we provide brief summaries of the currently accepted best practice in cost-effectiveness decision-making under uncertainty.
  • Cost-effectiveness, Modelling, Sensitivity-analysis
  • RePEc:wkh:phecon:v:23:y:2005:i:6:p:529-536
Language
  • English
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