Dealing with uncertainty in the economic evaluation of health care technologies

This collection of papers aims to addresses why, and how, uncertainty should be incorporated within economic evaluations of health care technologies and how the results can be used to inform decision making. Section one provides a brief overview of the methodological and policy background of using economic evaluation to inform decisions about health care technologies. With the context for utilising economic evaluation to inform reimbursement decisions established, sources of uncertainty are considered at each stage of the evaluation. Section two discusses the identification of relevant evidence to inform estimates of the effectiveness of health care technologies. The key uncertainty addressed is how to assess whether the available evidence can be analysed to provide an unbiased estimate of the treatment effect. As multiple sources of evidence may exist, Section three explains how they can be combined to sum up the available evidence, and in Section four the techniques for characterising uncertainty within that combined analysis are examined. Sections five and six demonstrate why a characterisation of uncertainty is crucial in order to inform decisions about the need for further research and the consequences of making reimbursement decisions under uncertainty. Methods to establish the opportunity cost of uncertainty and sufficiency of the evidence base are reviewed in Section five with a view to informing decisions to acquire further research. In Section six the irreversible aspects of reimbursement decisions, as well as the interdependence of decisions about reimbursement and about further research is illustrated. These factors spell out why an economic evaluation that does not deal with uncertainty will be inadequate for informing reimbursement decisions. Finally, Section seven concludes the thesis and summarises the contribution of the presented papers and areas for further research.