Incorporation of uncertainty in health economic modelling studies
Identifieur interne : 002B21 ( Main/Exploration ); précédent : 002B20; suivant : 002B22Incorporation of uncertainty in health economic modelling studies
Auteurs : Anthony O'Hagan [Royaume-Uni] ; Christopher Mccabe [Royaume-Uni] ; Ron Akehurst [Royaume-Uni] ; Alan Brennan [Royaume-Uni] ; Andrew Briggs [Royaume-Uni] ; Karl Claxton [Royaume-Uni] ; Elisabeth Fenwick [Royaume-Uni] ; Dennis Fryback [États-Unis] ; Mark Sculpher [Royaume-Uni] ; David Spiegelhalter [Royaume-Uni] ; Andrew Willan [Canada]Source :
- PharmacoEconomics : (Auckland) [ 1170-7690 ] ; 2005.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Modèle économique, Homme, Santé publique.
English descriptors
- KwdEn :
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.
Affiliations:
- Canada, Royaume-Uni, États-Unis
- Angleterre, Angleterre de l'Est, Ontario, Oxfordshire, Wisconsin
- Cambridge, Oxford, Toronto
- Université d'Oxford, Université de Cambridge, Université de Toronto
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d'Oxford</orgName></affiliation></author><author><name sortKey="Claxton, Karl" sort="Claxton, Karl" uniqKey="Claxton K" first="Karl" last="Claxton">Karl Claxton</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>York</wicri:noRegion></affiliation></author><author><name sortKey="Fenwick, Elisabeth" sort="Fenwick, Elisabeth" uniqKey="Fenwick E" first="Elisabeth" last="Fenwick">Elisabeth Fenwick</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>York</wicri:noRegion></affiliation></author><author><name sortKey="Fryback, Dennis" sort="Fryback, Dennis" uniqKey="Fryback D" first="Dennis" last="Fryback">Dennis 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Bayesian Statistics in Health Economics, Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Sheffield</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Sheffield</wicri:noRegion></affiliation></author><author><name sortKey="Mccabe, Christopher" sort="Mccabe, Christopher" uniqKey="Mccabe C" first="Christopher" last="Mccabe">Christopher Mccabe</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre for Bayesian Statistics in Health Economics, Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Sheffield</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Health Economics and Decision Science, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Sheffield</wicri:noRegion></affiliation></author><author><name sortKey="Akehurst, Ron" sort="Akehurst, Ron" uniqKey="Akehurst R" first="Ron" last="Akehurst">Ron Akehurst</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre for Bayesian Statistics in Health Economics, Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Sheffield</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Health Economics and Decision Science, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Sheffield</wicri:noRegion></affiliation></author><author><name sortKey="Brennan, Alan" sort="Brennan, Alan" uniqKey="Brennan A" first="Alan" last="Brennan">Alan Brennan</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre for Bayesian Statistics in Health Economics, Department of Probability and Statistics, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Sheffield</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Health Economics and Decision Science, University of Sheffield</s1><s2>Sheffield</s2><s3>GBR</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Sheffield</wicri:noRegion></affiliation></author><author><name sortKey="Briggs, Andrew" sort="Briggs, Andrew" uniqKey="Briggs A" first="Andrew" last="Briggs">Andrew Briggs</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Health Economics Research Centre, University of Oxford</s1><s2>Oxford</s2><s3>GBR</s3><sZ>5 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region><settlement type="city">Oxford</settlement></placeName><orgName type="university">Université d'Oxford</orgName></affiliation></author><author><name sortKey="Claxton, Karl" sort="Claxton, Karl" uniqKey="Claxton K" first="Karl" last="Claxton">Karl Claxton</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>York</wicri:noRegion></affiliation></author><author><name sortKey="Fenwick, Elisabeth" sort="Fenwick, Elisabeth" uniqKey="Fenwick E" first="Elisabeth" last="Fenwick">Elisabeth Fenwick</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>York</wicri:noRegion></affiliation></author><author><name sortKey="Fryback, Dennis" sort="Fryback, Dennis" uniqKey="Fryback D" first="Dennis" last="Fryback">Dennis Fryback</name><affiliation wicri:level="2"><inist:fA14 i1="06"><s1>University of Wisconsin Medical School</s1><s2>Madison, Wisconsin</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Wisconsin</region></placeName></affiliation></author><author><name sortKey="Sculpher, Mark" sort="Sculpher, Mark" uniqKey="Sculpher M" first="Mark" last="Sculpher">Mark Sculpher</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Centre for Health Economics, University of York</s1><s2>York</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>York</wicri:noRegion></affiliation></author><author><name sortKey="Spiegelhalter, David" sort="Spiegelhalter, David" uniqKey="Spiegelhalter D" first="David" last="Spiegelhalter">David Spiegelhalter</name><affiliation wicri:level="4"><inist:fA14 i1="07"><s1>MRC Biostatistics Unit, University of Cambridge</s1><s2>Cambridge</s2><s3>GBR</s3><sZ>10 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Cambridge</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Angleterre de l'Est</region></placeName><orgName type="university">Université de Cambridge</orgName></affiliation></author><author><name sortKey="Willan, Andrew" sort="Willan, Andrew" uniqKey="Willan A" first="Andrew" last="Willan">Andrew Willan</name><affiliation wicri:level="4"><inist:fA14 i1="08"><s1>Public Health Sciences, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>11 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author></analytic><series><title level="j" type="main">PharmacoEconomics : (Auckland)</title><title level="j" type="abbreviated">PharmacoEconomics : (Auckl. )</title><idno type="ISSN">1170-7690</idno><imprint><date when="2005">2005</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">PharmacoEconomics : (Auckland)</title><title level="j" type="abbreviated">PharmacoEconomics : (Auckl. )</title><idno type="ISSN">1170-7690</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antiparkinson agent</term><term>Cost efficiency analysis</term><term>Decision making</term><term>Economic model</term><term>Health economy</term><term>Human</term><term>Parkinson disease</term><term>Public health</term><term>Uncertainty</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Economie santé</term><term>Analyse coût efficacité</term><term>Prise décision</term><term>Modèle économique</term><term>Incertitude</term><term>Parkinson maladie</term><term>Antiparkinsonien</term><term>Homme</term><term>Santé publique</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Modèle économique</term><term>Homme</term><term>Santé publique</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><affiliations><list><country><li>Canada</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Angleterre de l'Est</li><li>Ontario</li><li>Oxfordshire</li><li>Wisconsin</li></region><settlement><li>Cambridge</li><li>Oxford</li><li>Toronto</li></settlement><orgName><li>Université d'Oxford</li><li>Université de Cambridge</li><li>Université de Toronto</li></orgName></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="O Hagan, Anthony" sort="O Hagan, Anthony" uniqKey="O Hagan A" first="Anthony" last="O'Hagan">Anthony O'Hagan</name></noRegion><name sortKey="Akehurst, Ron" sort="Akehurst, Ron" uniqKey="Akehurst R" first="Ron" last="Akehurst">Ron Akehurst</name><name sortKey="Akehurst, Ron" sort="Akehurst, Ron" uniqKey="Akehurst R" first="Ron" last="Akehurst">Ron Akehurst</name><name sortKey="Brennan, Alan" sort="Brennan, Alan" uniqKey="Brennan A" first="Alan" last="Brennan">Alan Brennan</name><name sortKey="Brennan, Alan" sort="Brennan, Alan" uniqKey="Brennan A" first="Alan" last="Brennan">Alan Brennan</name><name sortKey="Briggs, Andrew" sort="Briggs, Andrew" uniqKey="Briggs A" first="Andrew" last="Briggs">Andrew Briggs</name><name sortKey="Claxton, Karl" sort="Claxton, Karl" uniqKey="Claxton K" first="Karl" last="Claxton">Karl Claxton</name><name sortKey="Fenwick, Elisabeth" sort="Fenwick, Elisabeth" uniqKey="Fenwick E" first="Elisabeth" last="Fenwick">Elisabeth Fenwick</name><name sortKey="Mccabe, Christopher" sort="Mccabe, Christopher" uniqKey="Mccabe C" first="Christopher" last="Mccabe">Christopher Mccabe</name><name sortKey="Mccabe, Christopher" sort="Mccabe, Christopher" uniqKey="Mccabe C" first="Christopher" last="Mccabe">Christopher Mccabe</name><name sortKey="O Hagan, Anthony" sort="O Hagan, Anthony" uniqKey="O Hagan A" first="Anthony" last="O'Hagan">Anthony O'Hagan</name><name sortKey="Sculpher, Mark" sort="Sculpher, Mark" uniqKey="Sculpher M" first="Mark" last="Sculpher">Mark Sculpher</name><name sortKey="Spiegelhalter, David" sort="Spiegelhalter, David" uniqKey="Spiegelhalter D" first="David" last="Spiegelhalter">David Spiegelhalter</name></country><country name="États-Unis"><region name="Wisconsin"><name sortKey="Fryback, Dennis" sort="Fryback, Dennis" uniqKey="Fryback D" first="Dennis" last="Fryback">Dennis Fryback</name></region></country><country name="Canada"><region name="Ontario"><name sortKey="Willan, Andrew" sort="Willan, Andrew" uniqKey="Willan A" first="Andrew" last="Willan">Andrew Willan</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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