Handling uncertainty in economic evaluation

It is increasingly common to find the results of economic evaluations that report results in terms of cost per life year or cost per quality adjusted life year (QALY) grouped together for comparison in so called cost effectiveness league tables. It is worrying, however, that the rankings in such league tables are made on the basis of point estimates of cost effectiveness without any consideration for the inherent uncertainty involved in their calculation. Consider the figure, where the point estimates for seven different healthcare interventions are plotted in increasing order of magnitude. What is immediately apparent is that the range of uncertainty (shown by the size of the bars around the point estimates) is such that a completely different ranking than that obtained from the order of the point estimates is possible. If policymakers are to be fully informed …