Claxton Karl, Sculpher Mark, McCabe Chris, Briggs Andrew, Akehurst Ron, Buxton Martin, Brazier John, O'Hagan Tony
Centre for Health Economics, Department of Economics and Related Studies, University of York, UK.
Health Econ. 2005 Apr;14(4):339-47. doi: 10.1002/hec.985.
Recently the National Institute for Clinical Excellence (NICE) updated its methods guidance for technology assessment. One aspect of the new guidance is to require the use of probabilistic sensitivity analysis with all cost-effectiveness models submitted to the Institute. The purpose of this paper is to place the NICE guidance on dealing with uncertainty into a broader context of the requirements for decision making; to explain the general approach that was taken in its development; and to address each of the issues which have been raised in the debate about the role of probabilistic sensitivity analysis in general. The most appropriate starting point for developing guidance is to establish what is required for decision making. On the basis of these requirements, the methods and framework of analysis which can best meet these needs can then be identified. It will be argued that the guidance on dealing with uncertainty and, in particular, the requirement for probabilistic sensitivity analysis, is justified by the requirements of the type of decisions that NICE is asked to make. Given this foundation, the main issues and criticisms raised during and after the consultation process are reviewed. Finally, some of the methodological challenges posed by the need fully to characterise decision uncertainty and to inform the research agenda will be identified and discussed.
最近，英国国家卫生与临床优化研究所（NICE）更新了其技术评估方法指南。新指南的一个方面是要求对提交给该研究所的所有成本效益模型使用概率敏感性分析。本文的目的是将NICE关于处理不确定性的指南置于更广泛的决策要求背景下；解释其制定过程中采用的一般方法；并探讨在关于概率敏感性分析总体作用的辩论中提出的每个问题。制定指南最合适的起点是确定决策所需的条件。基于这些要求，然后可以确定最能满足这些需求的分析方法和框架。将论证，关于处理不确定性的指南，特别是对概率敏感性分析的要求，是由NICE被要求做出的决策类型的要求所证明的。在此基础上，回顾了咨询过程中及之后提出的主要问题和批评意见。最后，将确定并讨论因需要充分描述决策不确定性并为研究议程提供信息而带来的一些方法学挑战。
