Using a Modified Delphi Approach to Gain Consensus on Relevant Comparators in a Cost-Effectiveness Model: Application...

Area of Science:

• Health economics
• Medical decision making
• Prostate cancer research

Background:

• Cost-effectiveness analysis (CEA) requires clear decision questions, which can be challenging when expert opinions on relevant comparators differ.
• Prostate cancer screening presents a complex case study due to rapid advancements in risk stratification, biomarkers, and diagnostic technologies.

Purpose of the Study:

• To present a modified Delphi approach for resolving uncertainty in decision questions for CEA.
• To identify important prostate cancer screening strategies for inclusion in economic models.

Main Methods:

• A two-round, anonymous online questionnaire-based modified Delphi approach was employed.
• International experts (researchers, clinicians, decision-makers) were recruited using purposive and snowball sampling.
• Consensus was defined as >70% agreement and <15% disagreement on statements regarding screening strategies.

Main Results:

• Twenty participants completed Round 1 and 17 completed Round 2.
• Consensus was reached on comparing no formal screening, age-based, and various risk-based screening strategies.
• There was agreement on considering MRI in the screening pathway but disagreement on including novel biomarkers.

Conclusions:

• A modified Delphi approach is effective for identifying relevant comparators in economic evaluations, especially in rapidly evolving fields.
• This methodology aids in navigating decision-question uncertainty within cost-effectiveness analyses for prostate cancer screening.