HEE: Developing a reference protocol for expert elicitation in health care decision making

HEE：制定医疗保健决策中专家启发的参考协议

• 批准号: MR/N028511/1
• 负责人: Laura Bojke
• 金额: $ 47.07万
• 依托单位: University of York
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2016
• 资助国家: 英国
• 起止时间: 2016 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN028511%2F1
• 关键词: HEE; Developing; reference; protocol; expert

Where the budget for health care is limited, difficult decisions about the use of treatments are made by decision makers. They usually consider the benefits of each alternative treatment and select the one that is expected to maximise health. When the budget is limited, money spent on a new treatment will mean other patients may not have access to the same level of health care. A decision maker needs to weigh the health gains with the losses (cost-effectiveness). To establish cost-effectiveness, decisions are usually based on a mathematical model of the disease of interest and any treatments given. Inputs to a model, for example risk of a heart attack, are required. Due to uncertainty in the evidence, the cost-effectiveness of an intervention is often not known with certainty. However, it is important that the uncertainty in cost-effectiveness estimates is reflected in any analysis conducted. If not, any decisions can be potentially misleading. In situations where information is unavailable, the experience of experts is essential. The process by which the beliefs of experts can be formally collected and recorded is "expert elicitation". Expert elicitation has been used in many areas including volcanology and weather forecasts. A number of alternative protocols (guides to good practice) are available for the design, conduct and use of expert elicitation, but it is not clear if any of these can appropriately be used to inform decisions using cost-effectiveness evidence. The overall aim of this project is to establish a reference protocol for the elicitation of experts' judgements to inform health care decision making. To do this we plan a series of work packages:WP1 Appraisal of existing protocols for eliciting distributions We will critically review available guidance for elicitation; this will include published and unpublished literature. The principles of each method will be appraised in light of a set of requirements for health care decision making. Where the review identifies gaps in knowledge, targeted searches on the alternative methods proposed will allow advantages and disadvantages of each choice to be identified and any potential constraints to their application for cost-effectiveness analyses to be established. WP2 Eliciting distributions to represent parameter uncertaintyIn order to consider uncertainty in the health care decision making process, judgements elicited need to reflect the imperfect knowledge experts have. Within WP1 we will consider alternative methods to avoid experts expressing variability. In addition, there are alternative approaches to elicit judgements (group consensus and individual expert approaches) and these differ in terms of how well uncertainty is represented. To inform the choice of approach to elicitation we will conduct an experiment. WP3 Understanding and appropriately characterising between-expert variationIt is important to include inputs from a range of experts in generating estimates of cost-effectiveness. These must be combined and there are alternative methods to do this: consensus and individual methods. There has been comparison of methods; however, results do not clearly support one approach over another and it is unclear which method best represents both within expert uncertainty and across expert variability. Within this work-package, we will conduct an experiment to explore the ability of consensus methods to generate expressions of uncertainty, particularly where between-expert variation is also important. The experiment will also allow us to explore different methods of pooling individual judgements. EVALUATION: To demonstrate the usefulness of the protocol developed in WPs 1-3, we will conduct an elicitation exercise using the protocol developed to inform a decision making process in real time. York is an Assessment Group for NICEs technology and diagnostics assessment processes. We will conduct an elicitation exercise to inform a current decision.

在卫生保健预算有限的地方，决策者要作出关于使用治疗的困难决定。他们通常会考虑每种替代治疗的好处，并选择一种有望最大限度地提高健康的治疗方法。当预算有限时，花在新治疗上的钱将意味着其他患者可能无法获得相同水平的医疗保健。决策者需要权衡健康收益与损失（成本效益）。为了建立成本效益，决策通常基于感兴趣的疾病和任何治疗的数学模型。需要输入模型，例如心脏病发作的风险。由于证据的不确定性，干预措施的成本效益往往无法确定。然而，重要的是，成本效益估计数的不确定性应反映在所进行的任何分析中。否则，任何决定都可能产生误导。在没有资料的情况下，专家的经验至关重要。专家的信念被正式收集和记录的过程是“专家启发”。专家启发法已用于许多领域，包括火山学和天气预报。有一些替代协议（良好做法指南）可供设计、实施和使用专家邀请，但尚不清楚其中是否有任何协议可适当用于根据成本效益证据作出知情决定。该项目的总体目标是建立一个参考协议，以吸引专家的判断，为医疗保健决策提供信息。为了做到这一点，我们计划了一系列的工作包：WP 1评估现有的协议，以引发分布我们将严格审查现有的指南，以引发;这将包括已发表和未发表的文献。每种方法的原则将根据一套医疗保健决策的要求进行评估。在审查发现知识差距的情况下，对拟议的替代方法进行有针对性的搜索，将有助于确定每种选择的优缺点，并确定应用这些方法进行成本效益分析的任何潜在制约因素。WP 2诱导分布来表示参数不确定性为了考虑医疗保健决策过程中的不确定性，判断需要反映专家的不完善知识。在WP 1中，我们将考虑替代方法，以避免专家表达可变性。此外，还有其他方法来得出判断（群体共识和个别专家的方法），这些方法在如何代表不确定性方面有所不同。为了告知启发式方法的选择，我们将进行一个实验。理解和适当描述专家间的差异在产生成本效益估计时，包括一系列专家的投入是很重要的。这些必须结合起来，有替代方法来做到这一点：共识和个人的方法。已经对方法进行了比较;然而，结果并不明确支持一种方法优于另一种方法，并且不清楚哪种方法最能代表专家不确定性和专家间的变异性。在这个工作包中，我们将进行一个实验，以探索共识方法生成不确定性表达式的能力，特别是在专家之间的变化也很重要的情况下。实验还将使我们能够探索汇集个人判断的不同方法。评价：为了证明在WP 1-3中开发的协议的有用性，我们将使用开发的协议进行启发练习，以真实的时间通知决策过程。约克是NICE技术和诊断评估流程的评估小组。我们将进行一次启发练习，以告知当前的决定。

项目成果

Experiences of Structured Elicitation for Model-Based Cost-Effectiveness Analyses.

• DOI: 10.1016/j.jval.2018.01.019
• 发表时间: 2018-06
• 期刊: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
• 作者: Soares MO;Sharples L;Morton A;Claxton K;Bojke L
• 通讯作者: Bojke L

Reference Case Methods for Expert Elicitation in Health Care Decision Making.

• DOI: 10.1177/0272989x211028236
• 发表时间: 2022-03
• 期刊: Medical decision making : an international journal of the Society for Medical Decision Making
• 作者: Bojke L;Soares MO;Claxton K;Colson A;Fox A;Jackson C;Jankovic D;Morton A;Sharples LD;Taylor A
• 通讯作者: Taylor A

sj-docx-1-mdm-10.1177_0272989X211028236 - Supplemental material for Reference Case Methods for Expert Elicitation in Health Care Decision Making

sj-docx-1-mdm-10.1177_0272989X211028236 - 医疗保健决策中专家诱导参考案例方法的补充材料

• DOI: 10.25384/sage.15000500
• 发表时间: 2021
• 作者: Bojke L

Expert Judgement in Risk and Decision Analysis

风险与决策分析的专家判断

• 发表时间: 2020
• 作者: Bonnano PV, Morton A, Godman B.

Developing a reference protocol for expert elicitation in healthcare decision making

制定医疗保健决策中专家启发的参考协议

• 发表时间: 2021
• 作者: Bojke L