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Uncertainty around Health State Values Used in Cost-Effectiveness Analysis: How It Arises and How to Deal with It
David Parkin1,2, Andrew Briggs3, Giselle Abangma3
1City St George's, University of London, London UK.
Summary
Health state values (HSVs) in cost-effectiveness analyses have multiple uncertainties. Current methods often fail to fully address these, potentially misrepresenting the precision of quality-adjusted life-year gains and cost-effectiveness.
Area of Science:
- Health Economics
- Decision Science
- Public Health
Background:
- Health state values (HSVs) are crucial for cost-effectiveness analyses (CEAs) to calculate quality-adjusted life-years (QALYs).
- HSVs are subject to various uncertainties, including variability, heterogeneity, statistical, and methodological variations.
- Inadequate documentation and accounting for these uncertainties can lead to a false sense of precision in QALY gain and CEA estimates.
Purpose of the Study:
- To provide a comprehensive account of the sources of uncertainty in health state values.
- To detail how uncertainty arises in the elicitation and modeling of value sets.
- To encourage research into measuring and reporting uncertainty around HSVs for improved CEAs.
Main Methods:
- Review and synthesis of existing literature on uncertainty in health state value elicitation.
- Analysis of different types of uncertainty: variability, heterogeneity, statistical, and methodological.
- Examination of how these uncertainties interact and impact economic evaluation models.
Main Results:
- Identified multiple sources of uncertainty in HSVs, including variability, heterogeneity, statistical uncertainty, and methodological variation.
- Demonstrated that current practices often fail to fully document or account for these uncertainties.
- Highlighted that this oversight can mislead users regarding the precision of QALY gains and cost-effectiveness.
Conclusions:
- There is a need for more thorough recognition, measurement, and reporting of uncertainty in HSVs.
- Valuation studies should report uncertainty measures (e.g., standard errors) beyond point estimates.
- Improved reporting of HSV uncertainty is essential for enhancing the reliability of cost-effectiveness analyses and decision-making.
Keywords:
cost-effectiveness analysishealth state valueshealth technology assessmentquality-adjusted life yearsreporting standardssensitivity analysisuncertainty quantificationvaluation studiesMore Related Videos
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