Making best use of evidence for explicit decisions in health care

This thesis explores how decision makers can make best use of evidence to inform unavoidable decisions about the appropriate use of resources in health care. A central aspect of the work is that in addition to decisions directly about (the funding of) health care technologies it also considers that further research may be needed to substantiate these decisions. Joint decisions about funding technologies and further research require an appropriate evaluative basis. This thesis reports such a framework, which also identifies the critical assessments required and, importantly, demonstrates their feasibility and applicability to analysts and policymakers. The relevance of this work has been recognised by key policymakers and has informed the most recent update of the methodological guidance of the National Institute for Health and Care Excellence (NICE) in the UK. However, the development of a framework is necessary but not sufficient for ensuring that best use is made of evidence to inform these joint decisions. These decisions also require that the evidence base is appropriately described with uncertainties characterised explicitly. This thesis compiles a number of examples where standard methods would have fallen short and hence more novel approaches were required. The approaches used generally aim to: make best use of available data (even if related but not directly relevant to the decision problem) or generate evidence by appropriately eliciting the judgements of relevant experts. The examples provide important methodological and applied contributions that demonstrate both the feasibility and value of ensuring that unavoidable decisions are informed by the best use of evidence.