PharmacoEconomics

, Volume 23, Issue 6, pp 529–536

Incorporation of uncertainty in health economic modelling studies

  • Anthony O’Hagan
  • Christopher McCabe
  • Ron Akehurst
  • Alan Brennan
  • Andrew Briggs
  • Karl Claxton
  • Elisabeth Fenwick
  • Dennis Fryback
  • Mark Sculpher
  • David Spiegelhalter
  • Andrew Willan
Leading Article

DOI: 10.2165/00019053-200523060-00001

Cite this article as:
O’Hagan, A., McCabe, C., Akehurst, R. et al. Pharmacoeconomics (2005) 23: 529. doi:10.2165/00019053-200523060-00001
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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.

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Anthony O’Hagan
    • 1
    • 2
  • Christopher McCabe
    • 1
    • 3
  • Ron Akehurst
    • 1
    • 3
  • Alan Brennan
    • 1
    • 3
  • Andrew Briggs
    • 4
  • Karl Claxton
    • 5
  • Elisabeth Fenwick
    • 5
  • Dennis Fryback
    • 6
  • Mark Sculpher
    • 5
  • David Spiegelhalter
    • 7
  • Andrew Willan
    • 8
  1. 1.Centre for Bayesian Statistics in Health Economics, Department of Probability and StatisticsUniversity of SheffieldSheffieldUK
  2. 2.Department of Probability and StatisticsUniversity of SheffieldSheffieldUK
  3. 3.Health Economics and Decision ScienceUniversity of SheffieldSheffieldUK
  4. 4.Health Economics Research CentreUniversity of OxfordOxfordUK
  5. 5.Centre for Health EconomicsUniversity of YorkYorkUK
  6. 6.University of Wisconsin Medical SchoolMadisonUSA
  7. 7.MRC Biostatistics UnitUniversity of CambridgeCambridgeUK
  8. 8.Public Health SciencesUniversity of TorontoTorontoCanada