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A multi-stakeholder survey on communicating cost-effectiveness uncertainties to stakeholders: a case study of ICER
Jan-Willem Versteeg1, Wim G Goettsch1,2, Aukje K Mantel-Teeuwisse1
1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Science, Utrecht University, Utrecht 3584 CG, The Netherlands.
Introduction:
Cost-effectiveness analyses (CEA) are integral to health technology assessments performed by the US-based Institute for Clinical and Economic Review (ICER). This study aims to examine how stakeholder groups perceive and interpret ICER's communication on uncertainty in CEA findings.
Methods:
We performed a multi-stakeholder survey among individuals recruited via ICER's weekly update email (March/April 2025). The survey focused on 6 topics related to ICER's uncertainty communication based on the organization's published reference case, consisting of Likert-scale and open-ended questions. Results were analyzed descriptively with thematic analysis of open-ended responses.
Results:
Thirty-four responses were collected, representing different stakeholder groups. Results indicated that 16/18 of respondents found sensitivity analyses to be communicated clearly (varying by analysis type), while 9/17 found structural and parametric assumptions to be communicated clearly. Most report sections were understandable respondents, and 15/23 found the communication of uncertainty outside reports to be understandable. Thematic analysis identified scenario analyses, structural/parametric uncertainty communication, and stakeholder-tailored communications as areas for future enhancement.
Conclusions:
While methodological guidelines focus on quantifying uncertainty, limited guidance exists for communicating key facts on uncertainty to different stakeholder groups. This study highlights specific stakeholder-perceived areas for improvement. Future research could compare these results to other organizations.
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