The Role of Measurement Uncertainty in Health Technology Assessments (HTAs) of In Vitro Tests

Alison F. Smith (), Mike Messenger, Peter Hall and Claire Hulme
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Alison F. Smith: Leeds Institute of Health Sciences, University of Leeds
Mike Messenger: National Institute of Health Research (NIHR) Leeds In Vitro Diagnostic Co-operative (IVDC)
Peter Hall: University of Edinburgh
Claire Hulme: Leeds Institute of Health Sciences, University of Leeds

PharmacoEconomics, 2018, vol. 36, issue 7, No 8, 823-835

Abstract: Abstract Introduction Numerous factors contribute to uncertainty in test measurement procedures, and this uncertainty can have a significant impact on the downstream clinical utility and cost-effectiveness of testing strategies. Currently, however, there is no clear guidance concerning if or how such factors should be considered within Health Technology Assessments (HTAs) of tests. Objective The aim was to provide an introduction to key concepts in measurement uncertainty for the HTA community and to explore, via systematic review, current methods utilised within HTAs. Methods HTAs of in vitro tests including a model-based economic evaluation were identified via the Centre for Reviews and Dissemination (CRD) HTA database and key reimbursement authority websites. Data were extracted to explore the specific components of measurement uncertainty assessed and methods utilised. The findings were narratively synthesised. Results Of 107 identified HTAs, 20 (19%) attempted to assess components of measurement uncertainty: 15 did so via some form of pre-model assessment (such as a literature review or laboratory survey); four also included components within the economic model; and one considered measurement uncertainty within the model only. One study quantified the impact of measurement uncertainty on cost-effectiveness and found that this parameter significantly changed the results, but did not impact the overall decision uncertainty. Conclusion A minority of HTAs identified from this review used various approaches to assess and/or incorporate the impact of measurement uncertainty, indicating that these assessments are feasible. Uncertainty remains around best practice methodology for conducting such analyses; further research is required to ensure that future HTAs are fit for purpose.

Date: 2018
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DOI: 10.1007/s40273-018-0638-1

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