Incorporation of uncertainty in health economic modelling studies

Pharmacoeconomics. 2005;23(6):529-36. doi: 10.2165/00019053-200523060-00001.

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.

MeSH terms

  • Antiparkinson Agents / therapeutic use
  • Cost-Benefit Analysis / methods
  • Cost-Benefit Analysis / standards
  • Decision Making
  • Economics, Pharmaceutical / statistics & numerical data
  • Humans
  • Markov Chains
  • Models, Economic*
  • Parkinson Disease / drug therapy
  • Parkinson Disease / economics
  • Uncertainty*

Substances

  • Antiparkinson Agents