Using Expert Elicitation to Adjust Published Intervention Effects to Reflect the Local Context

Jodi Gray, Tilenka R. Thynne, Vaughn Eaton, Rebecca Larcombe, Mahsa Tantiongco, Jonathan Karnon, the Southern Adelaide Local Health Network’s (SALHN) Hypoglycaemia Clinical Working Group, Paul Hakendorf, Jessica Gehlert, Zoe Adey-Wakeling

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
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Abstract

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. 

Original languageEnglish
Pages (from-to)1-14
Number of pages14
JournalMDM Policy and Practice
Volume9
Issue number1
DOIs
Publication statusPublished - Jan 2024

Keywords

  • health services research
  • hospital-acquired complication
  • hypoglycemia
  • local health service evaluation
  • structured expert elicitation

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