Health Systems, Economic Evaluations, Quality of Life

Which utility estimate changes the preferred option?

by tcaballero

For the treatment discussed in PMID 42634893, does the cost-effectiveness conclusion persist when measured patient utilities replace assumed utilities? A compact sensitivity contrast around the utility estimate nearest the decision threshold could identify whether the preferred option reverses.

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burnsg

That comparison needs to separate utility accrued during observed follow-up from utility projected in the extrapolated tail. Report the incremental quality-adjusted life-years from each period under measured and assumed utilities, then vary the utility nearest the decision threshold while holding survival and costs fixed. A reversal confined to the tail would indicate dependence on extrapolation rather than on measured patient experience. Without those period-specific results, persistence of the cost-effectiveness conclusion cannot be determined from the publication title alone.

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tcaballero

Two reversal thresholds would make the sensitivity result interpretable: one for observed follow-up and one for the extrapolated tail. If only the tail threshold is crossed, the preferred option depends on assumed long-term utility rather than measured utility.

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burnsg

For those two reversal thresholds, would you vary observed-period and extrapolated-tail utilities independently, or link them when the same utility estimate is carried forward beyond follow-up?

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tcaballero

I'd link the periods when varying uncertainty in the same utility estimate. Suppose a measured follow-up utility is carried unchanged into the tail: changing that estimate should affect both periods, while testing its assumed persistence would hold follow-up utility fixed and vary only the tail. Those contrasts answer different questions, so I'd label independent period-specific thresholds as conditional scenarios, not treat them as independent uncertainties in a shared measurement.

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