Candidate for the Lee B. Lusted Student Prize Competition
Purpose: To illustrate by means of a case study how probability elicitation (PE) can be combined with health economic modeling (HEM) to perform an early-stage evaluation of a new medical product in the disease management of heart failure (HF) patients.
Methods: HEM is increasingly applied in the early stages of the product development process to support producers of health technology in making proper product investment decisions. Such evaluations are characterized by evidence scarcity as data from clinical research is still missing. This leads to high uncertainty in some of the model inputs, which can generally only be resolved by incorporating expert opinion. PE refers to the process of formulating an expert’s belief about the unknown quantities in a probability distribution for those quantities. In this study, we applied PE to perform an early-stage evaluation of a point-of-care testing device for measuring one or more circulating biomarkers in HF patients. First, conceptual models of the disease management (DM) strategies with and without the new device were developed. Next, a disease progression model was developed to estimate the non-device-related cost and effectiveness of both DM strategies. The model parameters that are likely to change under the new device strategy (uPoI) were identified and PE was subsequently applied to capture the probability distributions of the uPoI. Finally, the maximum additional cost at which the use of the device is still deemed cost-effective (headroom) was calculated and its uncertainty was captured probabilistically by propagating the uPoI distributions.
Results: Compared to the conventional DM strategy, the experts expected a slightly lower outpatient mortality and a lot lower inpatient mortality because of the new point-of-care technology. For 10,000 Monte Carlo iterations within 5 years time horizon, the resulting life expectancy and non-device-related costs were 1170 vs. 1210 days and €9920 vs. €9567. The resulting expected headroom was €2545 for a €20,000 willingness-to-pay per life year gained. In addition, it was found that there was a 24.7% probability that no room is available for further device-related investment.
Conclusions: This study builds up a connection between subjective evidence elicitation and early-stage HEM. Further research regarding how to proceed from getting the headroom to the product investment decision-making seems desirable.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making