TY - JOUR
T1 - Using Expert Elicitation to Adjust Published Intervention Effects to Reflect the Local Context
AU - Gray, Jodi
AU - Thynne, Tilenka R.
AU - Eaton, Vaughn
AU - Larcombe, Rebecca
AU - Tantiongco, Mahsa
AU - Karnon, Jonathan
AU - the Southern Adelaide Local Health Network’s (SALHN) Hypoglycaemia Clinical Working Group
AU - Reade, Brianna
AU - Baldacchino, Linda
AU - Hakendorf, Paul
AU - Gehlert, Jessica
AU - Adey-Wakeling, Zoe
AU - Hannan, Catherine
PY - 2024/1
Y1 - 2024/1
N2 - Background. Local health services make limited use of economic evaluation to inform decisions to fund new health service interventions. One barrier is the relevance of published intervention effects to the local setting, given these effects can strongly reflect the original evaluation context. Expert elicitation methods provide a structured approach to explicitly and transparently adjust published effect estimates, which can then be used in local-level economic evaluations to increase their local relevance. Expert elicitation was used to adjust published effect estimates for 2 interventions targeting the prevention of inpatient hypoglycemia. Methods. Elicitation was undertaken with 6 clinical experts. They were systematically presented with information regarding potential differences in patient characteristics and quality of care between the published study and local contexts, and regarding the design and application of the published study. The experts then assessed the intervention effects and provided estimates of the most realistic, most pessimistic, and most optimistic intervention effect sizes in the local context. Results. The experts estimated both interventions would be less effective in the local setting compared with the published effect estimates. For one intervention, the experts expected the lower complexity of admitted patients in the local setting would reduce the intervention’s effectiveness. For the other intervention, the reduced effect was largely driven by differences in the scope of implementation (hospital-wide in the local setting compared with targeted implementation in the evaluation). Conclusions. The pragmatic elicitation methods reported in this article provide a feasible and acceptable approach to assess and adjust published intervention effects to better reflect expected effects in the local context. Further development and application of these methods is proposed to facilitate the use of local-level economic evaluation.
AB - Background. Local health services make limited use of economic evaluation to inform decisions to fund new health service interventions. One barrier is the relevance of published intervention effects to the local setting, given these effects can strongly reflect the original evaluation context. Expert elicitation methods provide a structured approach to explicitly and transparently adjust published effect estimates, which can then be used in local-level economic evaluations to increase their local relevance. Expert elicitation was used to adjust published effect estimates for 2 interventions targeting the prevention of inpatient hypoglycemia. Methods. Elicitation was undertaken with 6 clinical experts. They were systematically presented with information regarding potential differences in patient characteristics and quality of care between the published study and local contexts, and regarding the design and application of the published study. The experts then assessed the intervention effects and provided estimates of the most realistic, most pessimistic, and most optimistic intervention effect sizes in the local context. Results. The experts estimated both interventions would be less effective in the local setting compared with the published effect estimates. For one intervention, the experts expected the lower complexity of admitted patients in the local setting would reduce the intervention’s effectiveness. For the other intervention, the reduced effect was largely driven by differences in the scope of implementation (hospital-wide in the local setting compared with targeted implementation in the evaluation). Conclusions. The pragmatic elicitation methods reported in this article provide a feasible and acceptable approach to assess and adjust published intervention effects to better reflect expected effects in the local context. Further development and application of these methods is proposed to facilitate the use of local-level economic evaluation.
KW - health services research
KW - hospital-acquired complication
KW - hypoglycemia
KW - local health service evaluation
KW - structured expert elicitation
UR - http://www.scopus.com/inward/record.url?scp=85183006710&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/9100002
U2 - 10.1177/23814683231226335
DO - 10.1177/23814683231226335
M3 - Article
AN - SCOPUS:85183006710
SN - 2381-4683
VL - 9
SP - 1
EP - 14
JO - MDM Policy and Practice
JF - MDM Policy and Practice
IS - 1
ER -