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Navigating time and uncertainty in health technology appraisal: would a map help?


  • Christopher McCabe

    () (School of Community Based Medicine, University of Alberta, Edmonton, Canada)

  • Richard Edlin

    (School of Population Health, University of Auckland, New Zealand)

  • Peter Hall

    (Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom)


Health care systems are increasingly under pressure to provide funding for innovative technologies. These technologies tend to be characterized by their potential to make valued contributions to patient health in areas of relative unmet need, high acquisition costs and great uncertainty in the evidence base on their actual impact on health. Decision makers are increasingly interested in linking reimbursement strategies to the degree of uncertainty in the evidence base and as a result, reimbursement for innovative technologies is frequently linked to some form of patient access or risk sharing scheme. However, current methods of economic evaluation provide only highly aggregate information on the distribution of risk between payers, patents and manufacturers. Reimbursement agencies would benefit from more detailed information on how uncertainty is distributed between costs and benefits; and over the short, medium and long term; to facilitate the assessment of the fairness of risk sharing under alternative payment strategies. In this paper we introduce the Net Benefit Probability Map as a method for providing decision makers with a less aggregate description of the distribution of costs, benefits and uncertainty over time, using data that is generated by standard probabilistic sensitivity analyses. We then show how it can be useful to decision makers considering (a) Only with Research Reimbursement decisions; (b) the use of differential discount rates; and (c) Patient access schemes.

Suggested Citation

  • Christopher McCabe & Richard Edlin & Peter Hall, 2012. "Navigating time and uncertainty in health technology appraisal: would a map help?," Working Papers 1201, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.
  • Handle: RePEc:lee:wpaper:1201

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    Download Restriction: The working paper can be downloaded from the web site of the Academic Unit of Health Economics. See 'Note'. This is a non-final version of an article published in final form in Pharmacoeconomics, 2013, 31(9), pp.731-7.

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    References listed on IDEAS

    1. Peter Hall & Claire Hulme & Christopher McCabe & Yemi Oluboyede & Jeff Round & David A Cameron, 2010. "Updated cost-effectiveness analysis of trastuzumab for early breast cancer:A UK perspective considering long-term toxicity and pattern of recurrence," Working Papers 1001, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.
    2. Karl Claxton & Mike Paulden & Hugh Gravelle & Werner Brouwer & Anthony J. Culyer, 2011. "Discounting and decision making in the economic evaluation of health‐care technologies," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 2-15, January.
    3. Karl Claxton & Stephen Palmer & Louise Longworth & Laura Bojke & Susan Griffin & Claire McKenna & Marta Soares & Eldon Spackman & Jihee Youn, 2011. "Uncertainty, evidence and irrecoverable costs: Informing approval, pricing and research decisions for health technologies," Working Papers 069cherp, Centre for Health Economics, University of York.
    4. Peter S Hall & Richard Edlin & Samer Kharroubi & Walter Gregory & Christopher McCabe, 2011. "Expected Net Present Value of Sample Information: from burden to investment," Working Papers 1101, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.
    5. Karl Claxton & Mark Sculpher & Anthony Culyer & Chris McCabe & Andrew Briggs & Ron Akehurst & Martin Buxton & John Brazier, 2006. "Discounting and cost-effectiveness in NICE - stepping back to sort out a confusion," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 1-4.
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    Cited by:

    1. Christopher McCabe & Richard Edlin & Peter Hall & Klemens Wallner, 2013. "Leasing health technologies- an affordable and effective reimbursement strategy for innovative technologies?," Working Papers 1302, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.
    2. James O’Mahony & Anthony Newall & Joost Rosmalen, 2015. "Dealing with Time in Health Economic Evaluation: Methodological Issues and Recommendations for Practice," PharmacoEconomics, Springer, vol. 33(12), pages 1255-1268, December.

    More about this item


    CEA; Uncertainty; Time; Decision making;


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