How Good Is Good Enough? A Simulation Study of Adaptive Health Technology Assessment

Area of Science:

• Health Economics
• Health Technology Assessment
• Decision Analysis

Background:

• Adaptive Health Technology Assessment (aHTA) involves evaluating healthcare interventions.
• Uncertainty in aHTA can influence crucial reimbursement decisions.
• Understanding factors contributing to this uncertainty is vital for accurate assessments.

Purpose of the Study:

• To evaluate the impact of uncertainty in aHTA on reimbursement decisions.
• To identify key factors contributing to uncertainty in aHTA.
• To quantify the financial risks associated with incorrect reimbursement decisions.

Main Methods:

• A simulation-based approach generated a distribution of aHTA Incremental Cost-Effectiveness Ratios (ICERs).
• ICERs were adjusted for currency, inflation, and technology price.
• Uncertainty was quantified by estimating the probability of wrong reimbursement decisions using willingness-to-pay (WTP) thresholds and a reference ICER from Thailand.

Main Results:

• The probability of incorrect decisions decreased when aHTA ICERs were far from the WTP threshold.
• Low variability in published ICERs, especially with similar methodologies, increased confidence.
• Technology price adjustments reduced variability; modest disease burden and lower costs correlated with smaller financial risks.

Conclusions:

• The aHTA approach is suitable when the ICER is clearly above or below the WTP threshold.
• Low variability among published ICERs enhances confidence in aHTA findings.
• Modest disease burden and financial risks are favorable conditions for aHTA suitability.