Uncertainty around Health State Values Used in Cost-Effectiveness Analysis: How It Arises and How to Deal with It.

Health state values, often in the form of value sets that list values applied to particular health states, are used in cost-effectiveness analyses of health care to calculate gains in quality-adjusted life-years. These values are subject to several sources of uncertainty, arising from the fact that...

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Publicado en:Medical Decision Making Vol. 46; no. 2; pp. 130 - 144
Autores principales: Parkin, David, Briggs, Andrew, Abangma, Giselle, Lloyd, Andrew, Devlin, Nancy
Formato: questions and answers review tables/charts Journal Article
Publicado: Sage Publications Inc. Feb2026
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Feb2026
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      pub: Sage Publications Inc.
      place: Thousand Oaks, California
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        atl: Uncertainty around Health State Values Used in Cost-Effectiveness Analysis: How It Arises and How to Deal with It.
      aug:
        au:
          Parkin, David
          Briggs, Andrew
          Abangma, Giselle
          Lloyd, Andrew
          Devlin, Nancy
        affil: Office of Health Economics, London UK
      sug:
        subj:
          Cost Effectiveness Analysis
          Health Status
          Quality-Adjusted Life Years
          Uncertainty
          Measurement Issues and Assessments
          Variable
          Data Analysis
          Sampling Error
          Technology, Medical
          Research Methodology
          Decision Making
      ab: Health state values, often in the form of value sets that list values applied to particular health states, are used in cost-effectiveness analyses of health care to calculate gains in quality-adjusted life-years. These values are subject to several sources of uncertainty, arising from the fact that values are not constants but variables and are of different types including variability, heterogeneity, statistical uncertainty, and methodological variation. Currently, these sources are not fully documented and are not fully accounted for when creating and analyzing economic evaluation models. This may provide to users of such models a false sense of the precision of quality-adjusted life-year gain estimates and therefore of cost-effectiveness. This article provides a comprehensive account of such sources of uncertainty and how they interact. It also provides a more detailed account of how uncertainty arises in studies that elicit and model value sets. Its aim is to encourage research to measure and report uncertainty around health state values so it can be better accounted for in cost-effectiveness analyses. Highlights: Health state values (HSVs) used in cost-effectiveness analysis are subject to multiple types of uncertainty, including variability, heterogeneity, statistical uncertainty, and methodological variation. Current reporting and guidelines often fail to fully document or address all sources of uncertainty in HSVs, which can mislead users about the precision of QALY and cost-effectiveness estimates. Valuation studies should report measures of uncertainty (such as standard errors or variance/covariance matrices) for HSVs, not just point estimates. Researchers, decision modellers, and guideline developers should recognise, measure, and report HSV uncertainty more thoroughly to improve the reliability of cost-effectiveness analyses.
      pubtype: Academic Journal
      doctype:
        questions and answers
        review
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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