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A Sensitivity Analysis Framework for Health Economic Evaluation in Middle Income Countries: Appropriately Incorporating a Comprehensive Approach
When constructing a health economic decision model, it is critical to select a sensitivity analysis approach appropriate for the decision context. This point is particularly salient to Middle-Income Countries (MICs), where there is relatively heightened resource scarcity and increased opportunity-co...
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| Format: | Thesis |
| Language: | English |
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Department of Public Health and Family Medicine
2022
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| _version_ | 1867613727177572352 |
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| access_status_str | Open Access |
| author | Soboil, Joshua |
| author2 | Cunnama, Lucy |
| author_browse | Cunnama, Lucy Soboil, Joshua |
| author_facet | Cunnama, Lucy Soboil, Joshua |
| author_sort | Soboil, Joshua |
| collection | Thesis |
| description | When constructing a health economic decision model, it is critical to select a sensitivity analysis approach appropriate for the decision context. This point is particularly salient to Middle-Income Countries (MICs), where there is relatively heightened resource scarcity and increased opportunity-cost. MICs face acute shortages of accessible as well as highquality evidence, resulting in a frequent imputing of data from external jurisdictions. Conversely, there are also shortages in skills and research capacity, creating a strong complementary need to consider the contextual feasibility of applying more resource demanding sensitivity analysis methodologies. Given the above, it is therefore critical to establish whether and when the technical benefits of complex and resource demanding methods result in real-world value. We apply a comparative case study using a comprehensive approach to decision-modelling, implemented in the R and JAGS languages. Specifically, the case study replicates a deterministic model originally used to inform the cost-effectiveness of adding a bivalent Human Papilloma Virus (HPV) vaccine to South Africa's public health care cervical cancer screening programme. Crucially, the case study provides critical insight into the pros and cons of implementing more complex sensitivity analysis techniques within MIC climates. Our findings indicate that the benefits of more advanced sensitivity analysis methods are nuanced; are therefore contextually beneficial according to a case-by-case basis; and, moreover, choosing a sensitivity analysis method should be guided by a conceptual ‘fruitfulness' (i.e. a bang-for-buck), more than a mere desire to reduce model complexity. To aid analysts in this process, from our comparative case study we provide a framework with three core concept areas namely Decision-Maker Preferences (Decision Power, Investment, Risk Aversion), Analytical Considerations (Available resources, Indirect Evidence) and Policy Context (Knowledge of Topic, Technical Expertise). The framework intends to encourage more judicious selection of sensitivity analysis methods; help reduce the methodological variation apparent in MIC settings; and simultaneously provide decision-makers with greater methodological transparency in the selection of sensitivity analysis methods. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/36127 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:40:44.577Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/36127 A Sensitivity Analysis Framework for Health Economic Evaluation in Middle Income Countries: Appropriately Incorporating a Comprehensive Approach Soboil, Joshua Cunnama, Lucy Wilkinson, Tommy Health Economics When constructing a health economic decision model, it is critical to select a sensitivity analysis approach appropriate for the decision context. This point is particularly salient to Middle-Income Countries (MICs), where there is relatively heightened resource scarcity and increased opportunity-cost. MICs face acute shortages of accessible as well as highquality evidence, resulting in a frequent imputing of data from external jurisdictions. Conversely, there are also shortages in skills and research capacity, creating a strong complementary need to consider the contextual feasibility of applying more resource demanding sensitivity analysis methodologies. Given the above, it is therefore critical to establish whether and when the technical benefits of complex and resource demanding methods result in real-world value. We apply a comparative case study using a comprehensive approach to decision-modelling, implemented in the R and JAGS languages. Specifically, the case study replicates a deterministic model originally used to inform the cost-effectiveness of adding a bivalent Human Papilloma Virus (HPV) vaccine to South Africa's public health care cervical cancer screening programme. Crucially, the case study provides critical insight into the pros and cons of implementing more complex sensitivity analysis techniques within MIC climates. Our findings indicate that the benefits of more advanced sensitivity analysis methods are nuanced; are therefore contextually beneficial according to a case-by-case basis; and, moreover, choosing a sensitivity analysis method should be guided by a conceptual ‘fruitfulness' (i.e. a bang-for-buck), more than a mere desire to reduce model complexity. To aid analysts in this process, from our comparative case study we provide a framework with three core concept areas namely Decision-Maker Preferences (Decision Power, Investment, Risk Aversion), Analytical Considerations (Available resources, Indirect Evidence) and Policy Context (Knowledge of Topic, Technical Expertise). The framework intends to encourage more judicious selection of sensitivity analysis methods; help reduce the methodological variation apparent in MIC settings; and simultaneously provide decision-makers with greater methodological transparency in the selection of sensitivity analysis methods. 2022-03-16T02:56:11Z 2022-03-16T02:56:11Z 2021 2022-03-16T02:07:33Z Master Thesis Masters MPH http://hdl.handle.net/11427/36127 eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences |
| spellingShingle | Health Economics Soboil, Joshua A Sensitivity Analysis Framework for Health Economic Evaluation in Middle Income Countries: Appropriately Incorporating a Comprehensive Approach |
| thesis_degree_str | Master's |
| title | A Sensitivity Analysis Framework for Health Economic Evaluation in Middle Income Countries: Appropriately Incorporating a Comprehensive Approach |
| title_full | A Sensitivity Analysis Framework for Health Economic Evaluation in Middle Income Countries: Appropriately Incorporating a Comprehensive Approach |
| title_fullStr | A Sensitivity Analysis Framework for Health Economic Evaluation in Middle Income Countries: Appropriately Incorporating a Comprehensive Approach |
| title_full_unstemmed | A Sensitivity Analysis Framework for Health Economic Evaluation in Middle Income Countries: Appropriately Incorporating a Comprehensive Approach |
| title_short | A Sensitivity Analysis Framework for Health Economic Evaluation in Middle Income Countries: Appropriately Incorporating a Comprehensive Approach |
| title_sort | sensitivity analysis framework for health economic evaluation in middle income countries appropriately incorporating a comprehensive approach |
| topic | Health Economics |
| url | http://hdl.handle.net/11427/36127 |
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