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- Title
Incorporation of uncertainty in health economic modelling studies.
- Authors
O'Hagan, Anthony; McCabe, Christopher; Akehurst, Ron; Brennan, Alan; Briggs, Andrew; Claxton, Karl; Fenwick, Elisabeth; Fryback, Dennis; Sculpher, Mark; Spiegelhalter, David; Willan, Andrew
- Abstract
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.
- Subjects
HEALTH planning; DRUGS; COST effectiveness; UNCERTAINTY; ECONOMIC models; COST analysis
- Publication
PharmacoEconomics, 2005, Vol 23, Issue 6, p529
- ISSN
1170-7690
- Publication type
journal article
- DOI
10.2165/00019053-200523060-00001