Neine Mohamed, Curran Desmond
GSK, Vaccines Value Evidence, Wavre, Belgium.
J Mark Access Health Policy. 2020 Dec 15;9(1):1857052. doi: 10.1080/20016689.2020.1857052.
: Assessment of uncertainty in cost-effectiveness analyses (CEAs) is paramount for decision-making. Probabilistic sensitivity analysis (PSA) estimates uncertainty by varying all input parameters simultaneously within predefined ranges; however, PSA often ignores correlations between parameters. : To implement an efficient algorithm that integrates parameter correlation in PSA. : An algorithm based on Cholesky decomposition was developed to generate multivariate non-normal parameter distributions for the age-dependent incidence of herpes zoster (HZ). The algorithm was implemented in an HZ CEA model and evaluated for gamma and beta distributions. The incremental cost-effectiveness ratio (ICER) and the probability of being cost-effective at a given ICER threshold were calculated for different levels of correlation. Five thousand Monte Carlo simulations were carried out. : Correlation coefficients between parameters sampled from the distribution generated by the algorithm matched the desired correlations for both distribution functions. With correlations set to 0.0, 0.5, and 0.9, 90% of the simulations showed ICERs below $25,000, $33,000, and $38,000 per quality-adjusted life-year (QALY), respectively, varying incidence only; and below $38,000, $48,000, and $58,000 per QALY, respectively, varying most parameters. : Parameter correlation may impact the uncertainty of CEA results. We implemented an efficient method for generating correlated non-normal distributions for use in PSA.
在成本效益分析(CEA)中评估不确定性对于决策至关重要。概率敏感性分析(PSA)通过在预定义范围内同时改变所有输入参数来估计不确定性;然而,PSA常常忽略参数之间的相关性。
为了实现一种在PSA中整合参数相关性的高效算法。
开发了一种基于乔列斯基分解的算法,用于生成带状疱疹(HZ)年龄依赖性发病率的多元非正态参数分布。该算法在HZ CEA模型中实现,并针对伽马分布和贝塔分布进行评估。针对不同的相关水平,计算了增量成本效益比(ICER)以及在给定ICER阈值下具有成本效益的概率。进行了5000次蒙特卡洛模拟。
从该算法生成的分布中采样得到的参数之间的相关系数与两种分布函数的期望相关性相匹配。将相关性设置为0.0、0.5和0.9时,仅改变发病率的情况下,90%的模拟显示ICER分别低于每质量调整生命年(QALY)25,000美元、33,000美元和38,000美元;改变大多数参数的情况下,分别低于每QALY 38,000美元、48,000美元和58,000美元。
参数相关性可能会影响CEA结果的不确定性。我们实现了一种用于生成相关非正态分布以用于PSA的高效方法。