Gray Jodi, Thynne Tilenka R, Eaton Vaughn, Larcombe Rebecca, Tantiongco Mahsa, Karnon Jonathan
Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
Flinders Medical Centre, Southern Adelaide Local Health Network (SALHN), Bedford Park, SA, Australia.
MDM Policy Pract. 2024 Jan 25;9(1):23814683231226335. doi: 10.1177/23814683231226335. eCollection 2024 Jan-Jun.
Local health services make limited use of economic evaluation to inform decisions to fund new health service interventions. One barrier is the relevance of published intervention effects to the local setting, given these effects can strongly reflect the original evaluation context. Expert elicitation methods provide a structured approach to explicitly and transparently adjust published effect estimates, which can then be used in local-level economic evaluations to increase their local relevance. Expert elicitation was used to adjust published effect estimates for 2 interventions targeting the prevention of inpatient hypoglycemia. Elicitation was undertaken with 6 clinical experts. They were systematically presented with information regarding potential differences in patient characteristics and quality of care between the published study and local contexts, and regarding the design and application of the published study. The experts then assessed the intervention effects and provided estimates of the most realistic, most pessimistic, and most optimistic intervention effect sizes in the local context. The experts estimated both interventions would be less effective in the local setting compared with the published effect estimates. For one intervention, the experts expected the lower complexity of admitted patients in the local setting would reduce the intervention's effectiveness. For the other intervention, the reduced effect was largely driven by differences in the scope of implementation (hospital-wide in the local setting compared with targeted implementation in the evaluation). The pragmatic elicitation methods reported in this article provide a feasible and acceptable approach to assess and adjust published intervention effects to better reflect expected effects in the local context. Further development and application of these methods is proposed to facilitate the use of local-level economic evaluation.
Local health services make limited use of economic evaluation to inform their decisions on the funding of new health service interventions. One barrier to use is the relevance of published intervention evaluations to the local setting.Expert elicitation methods provide a structured way to consider differences between the evaluation and local settings and to explicitly and transparently adjust published effect estimates for use in local economic evaluations.The pragmatic elicitation methods reported in this article offer a feasible and acceptable approach to adjusting published intervention effects to better reflect the effects expected in the local context. This increases the relevance of economic evaluations for local decision makers.
当地卫生服务机构在利用经济评估为新的卫生服务干预措施的资金决策提供信息方面做得有限。一个障碍是已发表的干预效果与当地情况的相关性，因为这些效果可能强烈反映原始评估背景。专家征询方法提供了一种结构化方法，用于明确且透明地调整已发表的效果估计值，然后可将其用于地方层面的经济评估，以提高其与当地的相关性。专家征询被用于调整针对预防住院患者低血糖的2种干预措施的已发表效果估计值。对6位临床专家进行了征询。系统地向他们展示了有关已发表研究与当地情况之间患者特征和护理质量的潜在差异，以及有关已发表研究的设计和应用的信息。然后，专家们评估了干预效果，并提供了在当地情况下最现实、最悲观和最乐观的干预效果大小估计值。专家们估计，与已发表的效果估计值相比，这两种干预措施在当地环境中的效果都会较差。对于一种干预措施，专家们预计当地住院患者较低的复杂性会降低该干预措施的有效性。对于另一种干预措施，效果降低主要是由实施范围的差异驱动的（在当地是全院范围，而在评估中是有针对性的实施）。本文报道的实用征询方法提供了一种可行且可接受的方法，用于评估和调整已发表的干预效果，以更好地反映当地情况下的预期效果。建议进一步开发和应用这些方法，以促进地方层面经济评估的使用。
当地卫生服务机构在利用经济评估为新的卫生服务干预措施的资金决策提供信息方面做得有限。使用的一个障碍是已发表的干预评估与当地情况的相关性。专家征询方法提供了一种结构化方式，以考虑评估与当地情况之间的差异，并明确且透明地调整已发表的效果估计值，用于地方经济评估。本文报道的实用征询方法提供了一种可行且可接受的方法，用于调整已发表的干预效果，以更好地反映当地情况下预期的效果。这增加了经济评估对地方决策者的相关性。
