Optimisation versus certainty : developing the use of economic evaluation for decision making.
Stevens, Warren;
(2000)
Optimisation versus certainty : developing the use of economic evaluation for decision making.
PhD thesis, London School of Hygiene & Tropical Medicine.
DOI: https://doi.org/10.17037/PUBS.00834549
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This thesis assesses the methods used in economic evaluation, the relationship of
economic evaluation to decision-making and investigates the possible limitations of
economic evaluation as it is currently used to support policies aimed at maximising
population health gain. It then evaluates alternative methods of analysing data from
economic evaluations to better inform policy decisions.
The hypothesis of this thesis is that a greater use of subgroup analysis in policy decisions
could potentially improve the efficiency of allocating scarce health care resources. This
study aims to investigate the impact on population health gain and service cost-
effectiveness of using subgroup analysis within defined parameters to derive and evaluate
estimates of effect, and compare it to the more traditional methods of statistical inference.
Data from existing large trials are used to calculate cost-effectiveness ratios for the total
study population and for subgroups. Total and subgroup estimates of cost-effectiveness
are applied to patient populations through simulation, and outcomes predicted on the
assumption that treatment decisions are guided by estimates derived from the trial. The
distribution of cost-effectiveness ratios based on different rules for `allowing' the use of
subgroup analysis results is compared with the distribution of cost-effectiveness ratios
based on aggregate analyses.
Results show that pre-selected subgroups can provide a stronger likelihood of maximising
overall health gain. This thesis argues for optimisation in the use and interpretation of
results rather than an over reliance on certainty and the resulting restriction on the use of
available data. It concludes that under the scrutiny of a health care system for which the
primary goal is health gain maximisation within resource constraints, policy decisions
made using the results of subgroup analysis could result in a more efficient allocation of
resources.