Abstract:
:Cost-effectiveness analysis (CEA) is one of the main tools of economic evaluation. Every CEA is based on a number of assumptions, some of which may not be accurate, introducing uncertainty. Sensitivity analysis (SA) formalizes ways to measure and evaluate this uncertainty. Specific sources of uncertainty in CEA have been noted by various researchers. In this work, we consolidate across all sources of uncertainty, discuss the imbalanced attention to SA across different sources, and discuss criteria for conducting and reporting SA to help bridge the gap between guidelines and practice. Guidelines on how to perform SA have been published for many years in response to requests for greater standardization among researchers. Decision makers tasked with reviewing new health technologies also seem to appreciate the additional information conveyed by a robust SA, including the attention to important patient subgroups. Yet, past reviews have shown that there is a substantial gap between the guidelines' suggestions and the quality of SA in the field. Past reviews have also focused on one or two but not all three sources of uncertainty. The objective of our work is to comprehensively review all different sources of uncertainty and provide a concise set of criteria for conducting and presenting SA, stratified by common modelling approaches, including decision analysis and regression models. We first provide an overview of the three sources of uncertainty in a CEA (parameter, structural and methodological), including patient heterogeneity. We then present results from a literature review of the conduct and reporting of SA based on 406 CEA articles published between 2000 and mid-2009. We find that a minority of papers addressed at least two of the three sources of uncertainty, with no change over time. On the other hand, the use of some sophisticated techniques, such as probabilistic SA, has surged over the past 10 years. Lastly, we identify criteria for reporting uncertainty-robust SA and also discuss how to conduct SA and how to improve the reporting of SA for decision makers. We recommend that researchers take a more comprehensive view of uncertainty when planning SA for an economic evaluation.
journal_name
Pharmacoeconomicsjournal_title
PharmacoEconomicsauthors
Jain R,Grabner M,Onukwugha Edoi
10.2165/11584630-000000000-00000subject
Has Abstractpub_date
2011-04-01 00:00:00pages
297-314issue
4eissn
1170-7690issn
1179-2027pii
3journal_volume
29pub_type
杂志文章,评审abstract:BACKGROUND:Healthcare resource use data were collected for 1 year as part of the CAESAR (Canada, Australia, Europe, South Africa) clinical trial, which evaluated the effect of adding lamivudine to treatment regimens containing zidovudine in patients with HIV infection. This study showed that lamivudine-containing regim...
journal_title:PharmacoEconomics
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.2165/00019053-199915001-00003
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND:Carcinoid syndrome, a rare condition in patients with neuroendocrine tumours, characterised by flushing and diarrhoea, severely affects patients' quality of life. The current carcinoid syndrome standard of care includes somatostatin analogues, but some patients experience uncontrolled symptoms despite somato...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-020-00896-5
更新日期:2020-06-01 00:00:00
abstract::The pharmacoeconomics of the low molecular weight heparin (LMWH) enoxaparin in the prophylaxis and treatment of venous thromboembolism have mostly been investigated in cost-effectiveness studies that estimated direct costs associated with treatment, using decision analyses and clinical outcome data from randomised con...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200220040-00002
更新日期:2002-01-01 00:00:00
abstract::The objective of this study was to demonstrate the cost effectiveness of long term maintenance treatment with citalopram versus standard therapy (defined as short term antidepressant treatment) in patients with major depression in Germany. We chose doxepin, amitriptyline and trimipramine as standard therapy because th...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199508020-00007
更新日期:1995-08-01 00:00:00
abstract::Lung cancer remains the leading cause of cancer-related death and economic burden worldwide. Despite the heavy toll of lung cancer, multiple new advances have improved patient outcomes, largely through precision medicine and targeted therapy. The associated rising economic burden however may impact the uptake of novel...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-017-0563-8
更新日期:2017-12-01 00:00:00
abstract::Hepatitis B virus (HBV) infection is an important public health problem all over the world. Vaccination is one way to prevent it, and several strategies can be used depending on endemicity, the main pattern of HBV transmission and the demographic structure of the population. In this study, an economic comparison of 3 ...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199507050-00007
更新日期:1995-05-01 00:00:00
abstract::Fluconazole (FLU) is an alternative to amphotericin B (AMB) for the treatment of candidemia in non-neutropenic patients. This agent has similar clinical efficacy but significantly reduced adverse effects compared with AMB. Using the database from a Canadian randomised multicentre comparative trial of FLU versus AMB in...
journal_title:PharmacoEconomics
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.2165/00019053-199813050-00004
更新日期:1998-05-01 00:00:00
abstract:BACKGROUND:Head and neck cancer (HNC) and its treatment can affect communication, nutrition, and physical appearance, and the global impact of this disease on patients' quality of life may be substantial. OBJECTIVE:The aim of this systematic literature review was to describe the impact of HNC and its treatment on the ...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-014-0199-x
更新日期:2014-12-01 00:00:00
abstract::Rheumatoid arthritis (RA) is a chronic, generally progressive autoimmune disease that causes functional disability, significant pain and joint destruction, and leads to premature mortality. It is estimated to affect between 0.5 and 1.0% of the adult population worldwide, increases in prevalence with age and affects mo...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-200422001-00002
更新日期:2004-01-01 00:00:00
abstract::Migraine headache is responsible for significantly more healthcare resource and lost labour costs than previously reported. Costs associated with migraine were assessed via a survey conducted in 940 patients, 70% of whom responded. All met the International Headache Society's diagnostic criteria for migraine and had ...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199202010-00008
更新日期:1992-07-01 00:00:00
abstract::Currently, the most important issue in US pharmaceutical policy is probably cost containment. Research into pharmaceutical issues should therefore concentrate on this area. Analysis of changing trends in pharmaceutical expenditures, particularly during the early 1990s, would be a useful starting point. Research into t...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199600102-00019
更新日期:1996-01-01 00:00:00
abstract::Health economic evaluation is a framework for the comparative analysis of the incremental health gains and costs associated with competing decision alternatives. The process of developing health economic models is usually complex, financially expensive and time-consuming. For these reasons, model development is someti...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-017-0553-x
更新日期:2017-11-01 00:00:00
abstract::The National Institute for Health and Care Excellence (NICE) invited GlaxoSmithKline, the manufacturer of dabrafenib, to submit evidence for the clinical and cost effectiveness of dabrafenib for the treatment of unresectable, advanced or metastatic BRAF V600 mutation-positive melanoma in accordance with the Institute'...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-015-0276-9
更新日期:2015-09-01 00:00:00
abstract::Health economic modelling studies are of interest to many parties with different responsibilities and diverging interests. Therefore, it is obvious that recognising the relevance of statistical uncertainty and dealing with it appropriately are required to obtain unbiased results from health economic modelling studies,...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200422120-00001
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVES:This study provides the results of a cost-effectiveness analysis of levetiracetam as an adjunctive treatment for refractory epilepsy from the Canadian Ministry of Health perspective. The main objective is to estimate the expected cost-effectiveness ratio expressed as the incremental cost per seizure-free day...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200523050-00008
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:Economic factors are a limiting factor toward the implementation of many health programmes and interventions. Economic evaluation has a great potential to contribute toward cost-effective healthcare delivery in South Africa. Little is known about the characteristics and quality of health economic (including ...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/11589450-000000000-00000
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Economic models are considered to be important, as they help evaluate the long-term impact of diabetes treatment. To date, it appears that no article has reviewed and critically appraised the cost-effectiveness models developed to evaluate new oral treatments [glucagon-like peptide-1 (GLP-1) receptor agonist...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-013-0117-7
更新日期:2014-01-01 00:00:00
abstract::Health reform is currently the predominant health policy issue in the US. It carries profound implications for the pharmaceutical field, including the possibility of price controls that could stifle pharmaceutical research. While policy makers are contemplating alternative approaches to reform, the marketplace for pha...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199400061-00018
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:The aim of the present study is to describe a refinement of a previously presented method, based on the concept of point sensitivity, to deal with uncertainty in economic studies. DESIGN:The original method was refined by the incorporation of probability distributions which allow a more accurate assessment o...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199916010-00004
更新日期:1999-07-01 00:00:00
abstract::This willingness-to-pay (WTP) analysis is the first study of its kind undertaken in Australia to support an application for listing of a new drug on the Australian national formulary. The technique offers the advantage of being able to summarise diverse outcomes of therapy in a single unit of measure. Willingness to p...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199813030-00009
更新日期:1998-03-01 00:00:00
abstract::Asian healthcare systems are very diverse, representing cultures, political systems and economies from more than 30 countries with varying histories. Despite the diversity in the region, there has been enormous growth in health economics and outcomes research since the beginning of the 21st century. Whilst Japan has s...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/11538360-000000000-00000
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Pharmacogenetics offers the potential to improve health outcomes by identifying individuals who are at greater risk of harm from certain medicines. Routine adoption of pharmacogenetic tests requires evidence of their cost effectiveness. OBJECTIVE:The present review aims to systematically review published ec...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-016-0397-9
更新日期:2016-08-01 00:00:00
abstract::Rufinamide (Inovelon®), a triazole derivative, is an oral antiepileptic drug approved in the EU as adjunctive therapy in the treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients aged ≥4 years. The efficacy of oral rufinamide as adjunctive therapy in patients with LGS uncontrolled on one to t...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/11208630-000000000-00000
更新日期:2012-03-01 00:00:00
abstract::Variable compliance with prescribed drug regimens is a leading source of variability in drug response. Specifics differ by drug and disease. The role of variable compliance was clearly defined in 2 trials of lipid-lowering agents, cholestyramine and gemfibrozil, in which exceptionally careful measurements of complianc...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199915030-00002
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVE:The aim of this review is to provide a summary of the literature on risk-sharing agreements, including conceptual, theoretical and empirical (number of agreements and their achievements) perspectives, and stakeholders' perceptions. METHODS:We conducted a systematic literature search in MEDLINE from 2000 to ...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-019-00838-w
更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:Over 200 million people have chronic obstructive pulmonary disease (COPD) worldwide. The number of disease-year equivalents and deaths attributable to COPD are high. Guidelines for the pharmacological treatment of the disease recommend an individualized step-up approach in which treatment is intensified when...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/11589270-000000000-00000
更新日期:2012-04-01 00:00:00
abstract::The application of cost-effectiveness methodology is particularly important in widespread diseases such as hypertension. However, because prospective cost-effectiveness analyses comparing different antihypertensive drugs are not currently available, differences in the cost effectiveness of these drugs can only be esti...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199508060-00006
更新日期:1995-12-01 00:00:00
abstract::The National Institute for Health and Care Excellence (NICE) is only one of several organisations internationally that uses economic evaluation as part of decision making regarding funding and pricing of new medical technologies. However, it can be argued that NICE has developed a more prominent international profile ...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-019-00882-6
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Intensive insulin therapy improves glycosylated haemoglobin (Hb(A1C)) levels and delays the onset of long-term diabetes-related complications. Current treatment guidelines recommend maintaining a glycosylated haemoglobin (Hb(A1C)) of < or = 7% in patients with type 1 and 2 diabetes mellitus. Ho...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200725030-00007
更新日期:2007-01-01 00:00:00
abstract:OBJECTIVE:The study objective was to evaluate and compare quality-of-life (QOL) parameters between patients with type 2 (non-insulin-dependent) diabetes mellitus who changed therapy from an oral hypoglycaemic agent (OHA) to insulin and those who remained on an OHA. DESIGN:The World Health Organization Quality of Life ...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199814020-00008
更新日期:1998-08-01 00:00:00