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The Application and Implications of Novel Deterministic Sensitivity Analysis Methods

Author

Listed:
  • Rick A. Vreman

    (Utrecht University
    The National Health Care Institute (ZIN))

  • Joost W. Geenen

    (Utrecht University
    Roche Nederland BV)

  • Saskia Knies

    (The National Health Care Institute (ZIN)
    Erasmus University Rotterdam)

  • Aukje K. Mantel-Teeuwisse

    (Utrecht University)

  • Hubert G. M. Leufkens

    (Utrecht University)

  • Wim G. Goettsch

    (Utrecht University
    The National Health Care Institute (ZIN))

Abstract

Deterministic sensitivity analyses (DSA) remain important to interpret the effect of uncertainties in individual parameters on results of cost-effectiveness analyses. Classic DSA methodologies may lead to wrong conclusions due to a lack of or misleading information regarding marginal effects, non-linearity, likelihood and correlations. In addition, tornado diagrams are misleading in some situations. Recent advances in DSA methods have the potential to provide decision makers with more reliable information regarding the effects of uncertainties in individual parameters. This practical application discusses advances to classic DSA methods and their implications. Three methods are discussed: stepwise DSA, distributional DSA and probabilistic DSA. For each method, the technical specifications, options for presenting results, and its implications for decision making are discussed. Options for visualizing DSA results in incremental cost-effectiveness ratios and in incremental net benefits are presented. The use of stepwise DSA increases interpretability of marginal effects and non-linearities in the model, which is especially relevant when arbitrary ranges are implemented. Using the probability distribution of each parameter in distributional DSA provides insight on the likelihood of model outcomes while probabilistic DSA also includes the effects of correlations between parameters. Probabilistic DSA, preferably expressed in incremental net benefit, is the most appropriate method for providing insight on the effect of uncertainty in individual parameters on the estimate of cost effectiveness. However, the opportunities provided by probabilistic DSA may not always be needed for decision making. Other DSA methods, in particular distributional DSA, can sometimes be sufficient depending on model features. Decision makers must determine to which extent they will accept and implement these new and improved DSA methodologies and adjust guidelines accordingly.

Suggested Citation

  • Rick A. Vreman & Joost W. Geenen & Saskia Knies & Aukje K. Mantel-Teeuwisse & Hubert G. M. Leufkens & Wim G. Goettsch, 2021. "The Application and Implications of Novel Deterministic Sensitivity Analysis Methods," PharmacoEconomics, Springer, vol. 39(1), pages 1-17, January.
    • Handle: RePEc:spr:pharme:v:39:y:2021:i:1:d:10.1007_s40273-020-00979-3
    DOI: 10.1007/s40273-020-00979-3
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    References listed on IDEAS

    as
    1. Mike Paulden, 2020. "Correction to: Calculating and Interpreting ICERs and Net Benefit," PharmacoEconomics, Springer, vol. 38(10), pages 1147-1147, October.
    2. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
    3. Rick A. Vreman & Joost W. Geenen & Anke M. Hövels & Wim G. Goettsch & Hubert G. M. Leufkens & Maiwenn J. Al, 2019. "Phase I/II Clinical Trial-Based Early Economic Evaluation of Acalabrutinib for Relapsed Chronic Lymphocytic Leukaemia," Applied Health Economics and Health Policy, Springer, vol. 17(6), pages 883-893, December.
    4. Mike Paulden, 2020. "Calculating and Interpreting ICERs and Net Benefit," PharmacoEconomics, Springer, vol. 38(8), pages 785-807, August.
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 18th January 2021
      by Chris Sampson in The Academic Health Economists' Blog on 2021-01-18 12:00:03

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