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Reference Case Methods for Expert Elicitation in Healthcare Decision Making

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JournalMedical Decision Making
DateAccepted/In press - 27 May 2021
Original languageEnglish


The evidence used to inform healthcare decision-making (HCDM) is typically uncertain. In these
situations, the experience of experts is essential to help decision makers reach a decision. Structured
expert elicitation (referred to as elicitation) is a quantitative process to capture experts’ beliefs.
There is heterogeneity in the existing elicitation methodology used in HCDM and it is not clear if
existing guidelines are appropriate for use in this context. In this paper we seek to establish
reference case methods for elicitation to inform HCDM.
We collated the methods available for elicitation using reviews and critique. In addition, we
conducted controlled experiments to test the accuracy of alternative methods. We determined the
suitability of the methods choices for use in HCDM according to a pre-defined set of principles for
elicitation in HCDM, which we have also generated. We determined reference case methods for
elicitation in HCDM for Health Technology Assessment (HTA).
In almost all methods choices available for elicitation, we found a lack of empirical evidence
supporting recommendations. Despite this it is possible to define reference case methods for HTA.
The reference methods include: a focus on gathering experts with substantive knowledge of the
quantities being elicited as opposed to those trained in probability and statistics, eliciting quantities
that the expert might observe directly, and individual elicitation of beliefs, rather than solely
consensus methods. It is likely that there are additional considerations for decision makers in
healthcare outside of HTA.
The reference case developed here allows the use of different methods, depending on the decision-making setting. Further applied examples of elicitation methods would be useful. Experimental
evidence comparing methods should be generated

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