title: Communicating the parameter uncertainty in the IQWiG efficiency frontier to decision-makers.
abstract: The Institute for Quality and Efficiency in Health Care (IQWiG) developed-in a consultation process with an international expert panel-the efficiency frontier (EF) approach to satisfy a range of legal requirements for economic evaluation in Germany's statutory health insurance system. The EF approach is distinctly different from other health economic approaches. Here, we evaluate established tools for assessing and communicating parameter uncertainty in terms of their applicability to the EF approach. Among these are tools that perform the following: (i) graphically display overall uncertainty within the IQWiG EF (scatter plots, confidence bands, and contour plots) and (ii) communicate the uncertainty around the reimbursable price. We found that, within the EF approach, most established plots were not always easy to interpret. Hence, we propose the use of price reimbursement acceptability curves-a modification of the well-known cost-effectiveness acceptability curves. Furthermore, it emerges that the net monetary benefit allows an intuitive interpretation of parameter uncertainty within the EF approach. This research closes a gap for handling uncertainty in the economic evaluation approach of the IQWiG methods when using the EF. However, the precise consequences of uncertainty when determining prices are yet to be defined.
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Stollenwerk
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Lhachimi
authors.forename: Andrew
authors.initials: A
authors.lastname: Briggs
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fenwick
authors.forename: Jaime J
authors.initials: JJ
authors.lastname: Caro
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.forename: Marion
authors.initials: M
authors.lastname: Danner
authors.forename: Andreas
authors.initials: A
authors.lastname: Gerber-Grote
mesh_terms: D000288:Administrative Personnel; D003142:Communication; D003362:Cost-Benefit Analysis; D004470:Economics, Medical / Q000706:statistics & numerical data; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data; D006291:Health Policy / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000706:statistics & numerical data; D008962:Models, Theoretical; D035501:Uncertainty
keywords: Germany; decision-making; economic evaluation; efficiency frontier; uncertainty