Informing reimbursement decisions using cost-effectiveness modelling: a guide to the process of generating elicited priors to capture model uncertainties

Laura Bojke, Bogdan Grigore, Dina Jankovic, Jaime Peters, Marta Ferreira Oliveira Soares, Ken Stein

Research output: Contribution to journalArticlepeer-review


In informing decisions, utilising health technology assessment (HTA), expert elicitation can provide valuable information, particularly where there is a less-developed evidence-base at the point of market access. In these circumstances, formal methods to elicit expert judgements are preferred to improve the accountability and transparency of the decision-making process, help reduce bias and the use of heuristics, and also provide a structure that allows uncertainty to be expressed. Expert elicitation is the process of transforming the subjective and implicit knowledge of experts into their quantifiable expressions. The use of expert elicitation in HTA is gaining momentum, and there is particular interest in its application to diagnostics, medical devices and complex interventions such as in public health or social care. Compared with the gathering of experimental evidence, elicitation constitutes a reasonably low-cost source of evidence. Given its inherent subject nature, the potential biases in elicited evidence cannot be ignored and, due to its infancy in HTA, there is little guidance to the analyst wishing to conduct a formal elicitation exercise. This article attempts to summarise the stages of designing and conducting an expert elicitation, drawing on key literature and examples, most of which are not in HTA. In addition, we critique their applicability to HTA, given its distinguishing features. There are a number of issues that the analyst should be mindful of, in particular the need to appropriately characterise the uncertainty associated with model inputs and the fact that there are often numerous parameters required, not all of which can be defined using the same quantities. This increases the need for the elicitation task to be as straightforward as possible for the expert to complete.

Original languageEnglish
Pages (from-to)867-877
Number of pages11
Issue number9
Early online date15 Jun 2017
Publication statusPublished - 1 Sept 2017

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© Springer 2017. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details

Funding Information:
No funding was received for the work carried out in the preparation of this manuscript. Laura Bojke was supported in the preparation/submission of this paper by the HEOM Theme of the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (NIHR CLAHRC YH; The views and opinions expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. Laura Bojke, Bogdan Grigore, Dina Jankovic, Jaime Peters, Marta Soares and Ken Stein have no conflicts of interest to declare.

Publisher Copyright:
© 2017, Springer International Publishing AG.

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