Altunkaya, James, Li, Xinyu, Adler, Amanda, Feenstra, Talitha, Fridhammar, Adam, Keng, Mi Jun, Lamotte, Mark, McEwan, Phil, Nilsson, Andreas, Palmer, Andrew J., Quan, Jianchao, Smolen, Harry, Tran-Duy, An, Valentine, William, Willis, Michael, Leal, José, and Clarke, Philip
The Mount Hood Diabetes Challenge Network aimed to examine the impact of model structural uncertainty on the estimated cost-effectiveness of interventions for type 2 diabetes. Ten independent modeling groups completed a blinded simulation exercise to estimate the cost-effectiveness of 3 interventions in 2 type 2 diabetes populations. Modeling groups were provided with a common baseline population, cost and utility values associated with different model health states, and instructions regarding time horizon and discounting. We collated the results to identify variation in predictions of net monetary benefit (NMB) and the drivers of those differences. Overall, modeling groups agreed which interventions had a positive NMB (ie, were cost-effective), Although estimates of NMB varied substantially—by up to £23 696 for 1 intervention. Variation was mainly driven through differences in risk equations for complications of diabetes and their implementation between models. The number of modeled health states was also a significant predictor of NMB. This exercise demonstrates that structural uncertainty between different health economic models affects cost-effectiveness estimates. Although it is reassuring that a decision maker would likely reach similar conclusions on which interventions were cost-effective using most models, the range in numerical estimates generated across different models would nevertheless be important for price-setting negotiations with intervention developers. Minimizing the impact of structural uncertainty on healthcare decision making therefore remains an important priority. Model registries, which record and compare the impact of structural assumptions, offer one potential avenue to improve confidence in the robustness of health economic modeling. • Structural uncertainty is known to be an important, but often unexamined, contributor to healthcare decision uncertainty. • Conducting a common simulation exercise across 10 independent modeling groups using uniform parameterization has allowed us to investigate the structural drivers of differences in cost-effectiveness estimates between diabetes models. We show how blinded simulation exercises can be used to quantitatively examine both the drivers and impact of structural uncertainty. Similar exercises could be replicated to examine the effect of structural uncertainty in healthcare decision problems in other disease areas. • This article demonstrates the value of incentivizing collaboration and comparative assessments among modeling groups to critically examine their modeling practice. This generates more robust evidence for decision making. Healthcare decision makers may benefit from directly facilitating collaboration between modeling groups, such as aiding funding and maintenance of model registries, which can demonstrate the relative suitability of different decision models for specific decision problems. [ABSTRACT FROM AUTHOR]