A comparison of two methods for expert elicitation in health technology assessments.
A comparison of two methods for expert elicitation in health technology assessments.
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DOI：
10.1186/s12874-016-0186-3
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发表时间：
2016-07-26
影响因子：
4
通讯作者：
Stein K
中科院分区：
文献类型：
--
作者：
Grigore B;Peters J;Hyde C;Stein K
当缺乏为决策模型中的参数提供信息所需的数据时，可以使用专家判断的正式引出来表征参数的不确定性。虽然有许多方法可以根据概率分布来征求专家意见，但很少有研究表明一种方法是否比其他方法更有用。本研究有三个目标：(i)获得表征卫生技术评估背景下参数不确定性的主观概率分布；（ii）以不同方式引出相同参数，比较两种引出方法；（iii）收集专家对所使用的不同启发方法的主观偏好。27名临床专家应邀参加了一项启发式活动，为一项已发表的基于模型的前列腺癌替代治疗的成本效益分析提供信息。参与者被单独要求用两种不同的方法——直方图法和混合启发法——以随机顺序表达他们的判断。个人分布在数学上由专家进行汇总，有和没有加权。将所得的组合分布用于决策模型的概率分析，计算每种方法的平均增量成本-效果比和完美信息期望值（EVPI），并与原始成本-效果分析结果进行比较。还记录了两种方法的易用性得分以及从每种方法获得的概率分布准确反映专家意见的程度。六位专家完成了这项任务。概率分析得出的平均ICERs在每个质量调整生命年（QALY） 162,600 - 175,500英镑之间，这取决于所使用的启发和加权方法。与没有信息相比，专家意见的使用降低了决策的不确定性：每个QALY阈值为30,000英镑的EVPI值比最初的成本效益分析降低了74 - 86%。专家指出，直方图方法更容易使用，但认为混合方法更准确。专家的启发可以减少决策的不确定性。在这里，方法的选择并不影响总体的成本效益结论，但是打算使用专家启发的研究人员需要意识到不同方法可能产生的影响。本文的在线版本（doi:10.1186/s12874-016-0186-3）包含补充材料，可供授权用户使用。
When data needed to inform parameters in decision models are lacking, formal elicitation of expert judgement can be used to characterise parameter uncertainty. Although numerous methods for eliciting expert opinion as probability distributions exist, there is little research to suggest whether one method is more useful than any other method. This study had three objectives: (i) to obtain subjective probability distributions characterising parameter uncertainty in the context of a health technology assessment; (ii) to compare two elicitation methods by eliciting the same parameters in different ways; (iii) to collect subjective preferences of the experts for the different elicitation methods used. Twenty-seven clinical experts were invited to participate in an elicitation exercise to inform a published model-based cost-effectiveness analysis of alternative treatments for prostate cancer. Participants were individually asked to express their judgements as probability distributions using two different methods – the histogram and hybrid elicitation methods – presented in a random order. Individual distributions were mathematically aggregated across experts with and without weighting. The resulting combined distributions were used in the probabilistic analysis of the decision model and mean incremental cost-effectiveness ratios and the expected values of perfect information (EVPI) were calculated for each method, and compared with the original cost-effectiveness analysis. Scores on the ease of use of the two methods and the extent to which the probability distributions obtained from each method accurately reflected the expert’s opinion were also recorded. Six experts completed the task. Mean ICERs from the probabilistic analysis ranged between £162,600–£175,500 per quality-adjusted life year (QALY) depending on the elicitation and weighting methods used. Compared to having no information, use of expert opinion decreased decision uncertainty: the EVPI value at the £30,000 per QALY threshold decreased by 74–86 % from the original cost-effectiveness analysis. Experts indicated that the histogram method was easier to use, but attributed a perception of more accuracy to the hybrid method. Inclusion of expert elicitation can decrease decision uncertainty. Here, choice of method did not affect the overall cost-effectiveness conclusions, but researchers intending to use expert elicitation need to be aware of the impact different methods could have. The online version of this article (doi:10.1186/s12874-016-0186-3) contains supplementary material, which is available to authorized users.