Health economic evaluations have recently become an important part of the clinical and medical research process and have built upon more advanced statistical decision-theoretic foundations. In some contexts, it is officially required that uncertainty about both parameters and observable variables be properly taken into account, increasingly often by means of Bayesian methods. Among these, probabilistic sensitivity analysis has assumed a predominant role. The objective of this article is to review the problem of health economic assessment from the standpoint of Bayesian statistical decision theory with particular attention to the philosophy underlying the procedures for sensitivity analysis.
BerwickD. Broadening the view of evidence-based medicine. Int J Qual Safe Health Care200514: 315–316.
2.
LeanMMannJHoekJElliotRSchofieldG. Translational research: from evidence-based medicine to sustainable solutions for public health problems. Brit Med J2008, pp. 337.
3.
WeinsteinMCStasonWB. Foundations of cost-effectiveness analysis for health and medical practices. New Engl J Med1977; 296(13): 716–721.
4.
BriggsASchulpherMClaxtonK. Decision modelling for health economic evaluation, Oxford, UK: Oxford University Press, 2006.
5.
WillanARBriggsA. The statistical analysis of cost-effectiveness data, Chichester, UK: John Wiley and Sons, 2006.
6.
O'HaganAStevensJ. A framework for cost-effectiveness analysis from clinical trial data. Health Econ2001; 10: 303–315.
7.
O'HaganAStevensJMontmartinJ. Bayesian cost effectiveness analysis from clinical trial data. Stat Med2001; 20: 733–753.
8.
ParmigianiG. Modeling in medical decision making, New York, NY: John Wiley and Sons, 2002.
9.
SpiegelhalterDBestN. Bayesian approaches to multiple sources of evidence and uncertainty in complex cost-effectiveness modelling. Statistics in Medicine2003; 22: 3687–3709.
10.
SpiegelhalterDAbramsKMylesJ. Bayesian Approaches to Clinical Trials and Health-Care Evaluation, Chichester, UK: John Wiley and Sons, 2004.
11.
LindleyD. Making Decisions, 2nd edition. London, UK: John Wiley and Sons, 1985.
12.
BaioGRussoP. A decision-theoretic framework for the application of cost-effectiveness analysis in regulatory processes. Pharmacoeconomics2009; 27(8): 645–655.
13.
ClaxtonKSchulpherMMcCabeC. Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra. Health Economics2005; 14: 339–347.
14.
de FinettiB. Theory of Probability1974; Vol. 1, New York, NY: John Wiley and Sons.
15.
TurnerDWailooACooperNSuttonAAbramsKNicholsonK. The cost-effectiveness of influenza vaccination of healthy adults 50-64 years of age. Vaccine2006; 24: 1035–1043.
16.
NicholKMallonKPM. Cost benefit of influenza vaccination in healthy, working adults: an economic analysis based on the results of a clinical trial of trivalent live attenuated influenza virus vaccine. Vaccine2003; 21(17-18): 2207–2217.
17.
DemicheliVRivettiDDeeksJJeffersonT. Vaccines for preventing influenza in healthy adults (Cochrane Review). Vol. Issue 4, Cochr Lib, 2004. 4.
18.
GrossPHermogenesASacksHLauJLevandowskiR. The efficacy of influenza vaccine in elderly persons — a meta analysis and review of the literature. Ann Intern Med1995; 123(7): 518–527.
19.
KindPBrooksRRabinR. EQ-5D concepts and methods: a developmental history, Dordrecht, The Netherlands: Springer, 2005.
20.
LoomesGMcKenzieL. The use of QALYs in health care decision making. Soc Sci Med1989; 28: 299–308.
21.
RobertC. The Bayesian choice, 2nd edition. New York, NY: Springer Verlag, 2001.
22.
RaiffaH. Decision Analysis – Introductory Lectures on Choices under Uncertainty, Reading, MA: Addison Wesley, 1968.
23.
StinnettAMullahyJ. Net health benefits: a new framework for the analysis of uncertainty in cost effectiveness analysis. Med Decis Making1998; 18(Suppl): S68–S80.
24.
KoerkampBHuninkMStijnenTHammittJ KuntzKWeinsteinM. Limitations of Acceptability Curves for Presenting Uncertainty in Cost-Effectiveness Analyses. Medical Decision Making2007; 27(2): 101–111.
25.
ClaxtonK. The irrelevance of inference: a decision-making approach to stochastic evaluation of health care technologies. J Health Econ1999; 18: 342–364.
26.
SaltelliATarantolaSCampolongoFRattoM. Sensitivity Analysis in Practice: A Guide to Assessing Scientific Models, Chichester, UK: John Wiley and Sons, 2004.
27.
JacksonCThompsonSSharplesL. Accounting for uncertainty in health economic decision models by using model averaging. J Royal Stat Soc A2009; 172(2): 383–404.
28.
OakleyJO'HaganA. Probabilistic Sensitivity Analysis of Complex Models: A Bayesian Approach. Journal of the Royal Statistical Society B2004; 66(3): 751–769.
DoubiletPBeggCBWeinsteinMCBraunPMcNeilBJ. Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach. Med Decis Making1985; 5: 157–177.
31.
BriggsAGoereeRBlackhouseGO' BrienBJ. Probabilistic Analysis of Cost-Effectiveness Models: Choosing between Treatment Strategies for Gastroesophageal Reflux Disease. Medical Decision Making2002; 4: 290–308.
32.
ParmigianiG. Measuring uncertainty in complex decision analysis models. Stat Methods Med Res2002; 11: 513–537.
33.
O'HaganAMc CabeCAkehurstRBrennanABriggsAClaxtonK. Incorporation of uncertainty in health economic modelling studies. Pharmacoeconomics2004; 23: 539–536.
34.
GriffinSClaxtonKHawkinsNSculpherM. Probabilistic Analysis and Computationally Expensive Models: Necessary and Required?Value Health2006; 9: 244–252.
35.
O'HaganAStevensonMMadanJ. Monte Carlo probabilistic sensitivity analysis for patient level simulation models: efficient estimation of mean and variance using ANOVA. Health Economics2007; 16: 1009–1023.
36.
van HoutBGordonMRuttenF. Costs, effects and C/E ratios alongside a clinical trial. Health Economics1994; 3: 309–319.
37.
FenwickEClaxtonKSchulpherM. Representing uncertainty: the role of cost effectiveness acceptability curves. Health Economics2001; 10: 779–787.
38.
BriggsA. Handling Uncertainty in Cost-Effectiveness Models. Pharmacoeconomics2000; 22: 479–500.
39.
O'HaganAStevensJMontmartinJ. Inference for the cost-effectiveness acceptability curve and cost-effectiveness ratio. Pharmacoeconomics2000; 17: 339–349.
40.
O'BrienBJBriggsA. Analysis of uncertainty in health care cost-effectiveness studies: an introduction to statistical issues and methods. Stat Methods Med Res2002; 11: 455–468.
41.
FelliJHazenG. A Bayesian approach to sensitivity analysis. Health Economics1999; 8: 263–268.
42.
HowardR. Information value theory. IEEE Trans Syst Sci Cybernetics SCC-21966; 2(1): 22–26.
43.
FelliJHazenG. Sensitivity analysis and the expected value of perfect information. Medical Decision Making1998; 18: 95–109.
44.
ClaxtonK. Bayesian approaches to the value of information: implications for the regulation of new pharmaceutical. Health Economics1999; 8: 269–274.
45.
ClaxtonKNeumannPArakiSWeinsteinM. Bayesian Value-Of-Information Analysis. Int. J. Technol. Assess. Health Care2001; 17: 38–55.
46.
AdesALuGClaxtonK. Expected Value of Sample Information Calculations in Medical Decision Modeling. Medical Decision Making2004; 24: 207–227.
47.
BrennanAKharroubiS. Efficient Computation of Partial Expected Value of Sample Information Using Bayesian Approximation, UK: Department of Probability and Statistics, University of Sheffield, 2005. 560/05.
48.
FenwickEPalmerSClaxtonKSculpherM AbramsKSuttonA. An Iterative Bayesian Approach to Health Technology Assessment: Application to a Policy of Preoperative Optimization for Patients Undergoing Major Elective Surgery. Medical Decision Making2006; 26: 480–496.
