How good is good enough? A simulation study of Adaptive HTA

Tools

Briones, Jamaica Roanne V and Baker, Peter and Isaranuwatchai, Wanrudee and Morton, Alec (2026) How good is good enough? A simulation study of Adaptive HTA. Value in Health. ISSN 1524-4733 (https://doi.org/10.1016/j.jval.2026.01.006)

[thumbnail of Briones-etal-VH-2026-A-simulation-study-of-Adaptive-HTA-1] Text. Filename: Briones-etal-VH-2026-A-simulation-study-of-Adaptive-HTA-1.pdf
Accepted Author Manuscript
Restricted to Repository staff only until 1 January 2099.
Download (1MB) | Request a copy

Abstract

This study evaluated how uncertainty in adaptive Health Technology Assessment (aHTA) impacts reimbursement decisions and identified factors contributing to this uncertainty. A simulation-based approach was employed to generate a distribution of aHTA Incremental Cost-Effectiveness Ratios (ICERs). ICERs sampled from systematic reviews of seven technologies were adjusted using: (i) USD adjustment for currency and inflation, and (ii) technology-price adjustment. Uncertainty in aHTA was quantified by estimating the probability of wrong reimbursement decisions using a willingness-to-pay (WTP) threshold-based decision rule. This involved comparing decisions based on the simulated aHTA ICER against a decision based on a known ICER from Thailand, serving as the "true" reference ICER. Financial risk of wrong reimbursement decisions from the aHTA approach was also quantified. The probability of wrong decisions from aHTA decreased when aHTA ICERs were clearly above or below the WTP threshold. Low variability among published ICERs, particularly when studies shared a similar methodological framework, improved confidence in aHTA. Simple adjustments to ICERs, such as technology-price adjustments, showed potential in reducing variability across studies. Technologies with modest disease burden and lower cost were associated with smaller financial risks, even under uncertain evidence. The aHTA approach is likely suitable under three conditions: (a) when the aHTA ICER is clearly positioned far from a country's WTP threshold; (b) when published ICERs exhibit low variability; and (c) when disease burden and financial risks are modest. [Abstract copyright: Copyright © 2026. Published by Elsevier Inc.]

ORCID iDs

Briones, Jamaica Roanne V, Baker, Peter, Isaranuwatchai, Wanrudee and Morton, Alec ORCID logoORCID: https://orcid.org/0000-0003-3803-8517;
CORE (COnnecting REpositories)