Methods for Communicating the Impact of Parameter Uncertainty in a Multiple-Strategies Cost-Effectiveness Comparison.
Methods for Communicating the Impact of Parameter Uncertainty in a Multiple-Strategies Cost-Effectiveness Comparison.
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DOI：
10.1177/0272989x221100112
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发表时间：
2022-10
影响因子：
3.6
通讯作者：
Coupe, Veerle M. H.
中科院分区：
文献类型：
--
作者：
Wolff, Henri B.;Qendri, Venetia;Kunst, Natalia;Alarid-Escudero, Fernando;Coupe, Veerle M. H.
分析和沟通不确定性在医疗决策中至关重要。为了判断风险是否可以接受，决策者需要关于预期结果的信息，也需要关于与所选战略有关的不确定性和潜在损失的信息。我们的目的是比较用于表示涉及许多策略的决策问题中的不确定性的影响的方法，增强现有的方法，并提供一个开源和易于使用的工具。我们进行了系统的文献检索，以确定用于代表成本效益分析比较多种策略的不确定性的影响的方法。我们将所确定的方法应用于3个已发表的决策分析模型的概率敏感性分析输出，比较多种策略。随后，我们比较了以下特征：传递的信息类型，使用固定或灵活的支付意愿阈值，输出的可解释性和图形的区分能力。我们进一步提出了方法的调整和整合，以克服现有方法的局限性。通过文献检索，选择了9种方法。比较多种策略最有利的3种方法是：1）成本-效果可接受性曲线（CEAC）和成本-效果可接受性边界（CEAF），2）预期损失曲线（ELC）和3）增量效益曲线（IBC）。评估决策信心所需的信息通常包括与每种策略相关的平均损失和成本效益概率。因此，我们建议将ELC和CEAC中呈现的信息整合到单个热图中。本文综述了多战略成本效益分析中的不确定性方法，并指出了它们的优缺点。我们提出了一种热图作为替代方法，它集成了卫生政策和医疗决策所需的所有相关信息。为了评估对所选行动方针的信心，决策者需要关于作出错误决定的概率和后果的信息。本文概述了在多策略成本效益分析中呈现不确定性的方法。我们提出了一个热图，结合成本效益的可接受性曲线（CEAC）的成本效益的概率与预期损失曲线的错误决策的后果。正如本文所建议的，通过放松CEAC可以减少CEAC的塌陷。提供了Microsoft Excel和R中的代码，以便使用本文中讨论的方法轻松分析数据。
Analyzing and communicating uncertainty is essential in medical decision making. To judge whether risks are acceptable, policy makers require information on the expected outcomes but also on the uncertainty and potential losses related to the chosen strategy. We aimed to compare methods used to represent the impact of uncertainty in decision problems involving many strategies, enhance existing methods, and provide an open-source and easy-to-use tool. We conducted a systematic literature search to identify methods used to represent the impact of uncertainty in cost-effectiveness analyses comparing multiple strategies. We applied the identified methods to probabilistic sensitivity analysis outputs of 3 published decision-analytic models comparing multiple strategies. Subsequently, we compared the following characteristics: type of information conveyed, use of a fixed or flexible willingness-to-pay threshold, output interpretability, and the graphical discriminatory ability. We further proposed adjustments and integration of methods to overcome identified limitations of existing methods. The literature search resulted in the selection of 9 methods. The 3 methods with the most favorable characteristics to compare many strategies were 1) the cost-effectiveness acceptability curve (CEAC) and cost-effectiveness acceptability frontier (CEAF), 2) the expected loss curve (ELC), and 3) the incremental benefit curve (IBC). The information required to assess confidence in a decision often includes the average loss and the probability of cost-effectiveness associated with each strategy. Therefore, we proposed the integration of information presented in an ELC and CEAC into a single heat map. This article presents an overview of methods presenting uncertainty in multiple-strategy cost-effectiveness analyses, with their strengths and shortcomings. We proposed a heat map as an alternative method that integrates all relevant information required for health policy and medical decision making. To assess confidence in a chosen course of action, decision makers require information on both the probability and the consequences of making a wrong decision. This article contains an overview of methods for presenting uncertainty in multiple-strategy cost-effectiveness analyses. We propose a heat map that combines the probability of cost-effectiveness from the cost-effectiveness acceptability curve (CEAC) with the consequences of a wrong decision from the expected loss curve. Collapsing of the CEAC can be reduced by relaxing the CEAC, as proposed in this article. Code in Microsoft Excel and R is provided to easily analyze data using the methods discussed in this article.