HEE: Developing a reference protocol for expert elicitation in health care decision making

HEE：制定医疗保健决策中专家启发的参考协议

基本信息

批准号：
MR/N028511/1
负责人：
Laura Bojke
金额：
$ 47.07万
依托单位：
University of York
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2016
资助国家：
英国
起止时间：
2016 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FN028511%2F1
关键词：
HEE Developing reference protocol expert

项目摘要

Where the budget for health care is limited, difficult decisions about the use of treatments are made by decision makers. They usually consider the benefits of each alternative treatment and select the one that is expected to maximise health. When the budget is limited, money spent on a new treatment will mean other patients may not have access to the same level of health care. A decision maker needs to weigh the health gains with the losses (cost-effectiveness). To establish cost-effectiveness, decisions are usually based on a mathematical model of the disease of interest and any treatments given. Inputs to a model, for example risk of a heart attack, are required. Due to uncertainty in the evidence, the cost-effectiveness of an intervention is often not known with certainty. However, it is important that the uncertainty in cost-effectiveness estimates is reflected in any analysis conducted. If not, any decisions can be potentially misleading. In situations where information is unavailable, the experience of experts is essential. The process by which the beliefs of experts can be formally collected and recorded is "expert elicitation". Expert elicitation has been used in many areas including volcanology and weather forecasts. A number of alternative protocols (guides to good practice) are available for the design, conduct and use of expert elicitation, but it is not clear if any of these can appropriately be used to inform decisions using cost-effectiveness evidence. The overall aim of this project is to establish a reference protocol for the elicitation of experts' judgements to inform health care decision making. To do this we plan a series of work packages:WP1 Appraisal of existing protocols for eliciting distributions We will critically review available guidance for elicitation; this will include published and unpublished literature. The principles of each method will be appraised in light of a set of requirements for health care decision making. Where the review identifies gaps in knowledge, targeted searches on the alternative methods proposed will allow advantages and disadvantages of each choice to be identified and any potential constraints to their application for cost-effectiveness analyses to be established. WP2 Eliciting distributions to represent parameter uncertaintyIn order to consider uncertainty in the health care decision making process, judgements elicited need to reflect the imperfect knowledge experts have. Within WP1 we will consider alternative methods to avoid experts expressing variability. In addition, there are alternative approaches to elicit judgements (group consensus and individual expert approaches) and these differ in terms of how well uncertainty is represented. To inform the choice of approach to elicitation we will conduct an experiment. WP3 Understanding and appropriately characterising between-expert variationIt is important to include inputs from a range of experts in generating estimates of cost-effectiveness. These must be combined and there are alternative methods to do this: consensus and individual methods. There has been comparison of methods; however, results do not clearly support one approach over another and it is unclear which method best represents both within expert uncertainty and across expert variability. Within this work-package, we will conduct an experiment to explore the ability of consensus methods to generate expressions of uncertainty, particularly where between-expert variation is also important. The experiment will also allow us to explore different methods of pooling individual judgements. EVALUATION: To demonstrate the usefulness of the protocol developed in WPs 1-3, we will conduct an elicitation exercise using the protocol developed to inform a decision making process in real time. York is an Assessment Group for NICEs technology and diagnostics assessment processes. We will conduct an elicitation exercise to inform a current decision.

在医疗保健预算有限的情况下，决策者会做出有关使用治疗方法的艰难决定。他们通常会考虑每种替代疗法的好处，并选择一种有望最大限度地提高健康水平的疗法。当预算有限时，花在新治疗上的钱将意味着其他患者可能无法获得相同水平的医疗保健。决策者需要权衡健康收益与损失（成本效益）。为了确定成本效益，决策通常基于感兴趣的疾病和所给出的任何治疗的数学模型。需要输入模型，例如心脏病发作的风险。由于证据的不确定性，干预措施的成本效益通常无法确定。然而，重要的是，成本效益估计的不确定性必须反映在进行的任何分析中。如果不是，任何决定都可能具有误导性。在无法获得信息的情况下，专家的经验至关重要。正式收集和记录专家信念的过程就是“专家启发”。专家启发已应用于许多领域，包括火山学和天气预报。许多替代方案（良好实践指南）可用于专家启发的设计、实施和使用，但尚不清楚这些方案是否可以适当地用于利用成本效益证据为决策提供信息。该项目的总体目标是建立一个参考方案，以征求专家的判断，为医疗保健决策提供信息。为此，我们计划了一系列工作包：WP1 评估现有的获取分布协议我们将严格审查现有的获取指南；这将包括已出版和未出版的文献。每种方法的原则将根据医疗保健决策的一系列要求进行评估。在审查发现知识差距的情况下，对所提出的替代方法进行有针对性的搜索将能够确定每种选择的优点和缺点，并确定其应用成本效益分析的任何潜在限制。 WP2 导出代表参数不确定性的分布为了考虑医疗保健决策过程中的不确定性，导出的判断需要反映专家所拥有的不完善的知识。在 WP1 中，我们将考虑替代方法来避免专家表达差异。此外，还有其他方法来引发判断（群体共识和个人专家方法），这些方法在不确定性的表示程度方面有所不同。为了告知启发方法的选择，我们将进行一项实验。 WP3 理解并适当描述专家之间的差异在生成成本效益估算时纳入一系列专家的意见非常重要。这些必须结合起来，并且有替代方法可以做到这一点：共识方法和个人方法。对方法进行了比较；然而，结果并没有明确支持一种方法优于另一种方法，并且尚不清楚哪种方法最能代表专家的不确定性和专家的可变性。在这个工作包中，我们将进行一项实验，探索共识方法生成不确定性表达的能力，特别是在专家之间的差异也很重要的情况下。该实验还将使我们能够探索汇集个人判断的不同方法。评估：为了证明 WP 1-3 中开发的协议的有用性，我们将使用开发的协议进行启发练习，以实时通知决策过程。约克是 NICE 技术和诊断评估流程的评估小组。我们将进行一次启发活动，以告知当前的决定。

项目成果

期刊论文数量（9）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Experiences of Structured Elicitation for Model-Based Cost-Effectiveness Analyses.

DOI：
10.1016/j.jval.2018.01.019
发表时间：
2018-06
期刊：
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
影响因子：
0
作者：
Soares MO;Sharples L;Morton A;Claxton K;Bojke L
通讯作者：
Bojke L

Reference Case Methods for Expert Elicitation in Health Care Decision Making.

DOI：
10.1177/0272989x211028236
发表时间：
2022-03
期刊：
Medical decision making : an international journal of the Society for Medical Decision Making
影响因子：
0
作者：
Bojke L;Soares MO;Claxton K;Colson A;Fox A;Jackson C;Jankovic D;Morton A;Sharples LD;Taylor A
通讯作者：
Taylor A

sj-docx-1-mdm-10.1177_0272989X211028236 - Supplemental material for Reference Case Methods for Expert Elicitation in Health Care Decision Making

sj-docx-1-mdm-10.1177_0272989X211028236 - 医疗保健决策中专家诱导参考案例方法的补充材料