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Exploring Model Uncertainty in Economic Evaluation of Health Interventions: The Example of Rotavirus Vaccination in Vietnam

Author

Listed:
  • Sun-Young Kim

    (Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts, sykim@hsph.harvard.edu, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts)

  • Sue J. Goldie

    (Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts)

  • Joshua A. Salomon

    (Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts, Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts)

Abstract

Objective . Motivated by observed discrepancies between 2 published studies on the cost-effectiveness of rotavirus vaccination in Vietnam, the authors’ objectives were to illustrate a specific, systematic approach to assessing model (structure and process) uncertainty and to quantify explicitly the contributions of different sources of variation in the outputs of different studies that share the same research question. Methods . On the basis of a series of working definitions of key model elements, the authors developed 5 alternative computer simulation (state-transition) models of rotavirus disease. They examined how epidemiological outcomes and cost-effectiveness ratios associated with rotavirus vaccination would change as elements of model structure and modeling process were progressively modified. They also explicitly decomposed the relative contributions of different modeling elements to differences in the cost-effectiveness results between the 2 previous analyses motivating the present study. Results . The findings suggest that within the category of a static, deterministic, aggregate-level model, different choices in model structure and process lead to relatively modest differences in the estimated cost-effectiveness of rotavirus vaccination, but that intermediate epidemiologic outcomes vary more substantially depending on the choice of model structure. Conclusions . The authors caution against generalizing the quantitative results in this study beyond the present example but suggest that the approach presented here may serve as a template for other examinations of model uncertainty. As new research questions arise after the introduction of rotavirus vaccination programs, a reevaluation of model uncertainty is likely to be needed.

Suggested Citation

  • Sun-Young Kim & Sue J. Goldie & Joshua A. Salomon, 2010. "Exploring Model Uncertainty in Economic Evaluation of Health Interventions: The Example of Rotavirus Vaccination in Vietnam," Medical Decision Making, , vol. 30(5), pages 1-28, September.
    • Handle: RePEc:sae:medema:v:30:y:2010:i:5:p:e1-e28
    DOI: 10.1177/0272989X10375579
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    References listed on IDEAS

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    1. Laura Bojke & Karl Claxton & Stephen Palmer & Mark Sculpher, 2006. "Defining and characterising structural uncertainty in decision analytic models," Working Papers 009cherp, Centre for Health Economics, University of York.
    2. Sun-Young Kim & Sue Goldie, 2008. "Cost-Effectiveness Analyses of Vaccination Programmes," PharmacoEconomics, Springer, vol. 26(3), pages 191-215, March.
    3. Jonathan Karnon, 2003. "Alternative decision modelling techniques for the evaluation of health care technologies: Markov processes versus discrete event simulation," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 837-848, October.
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