Uncertainty in economic evaluation: a pragmatic guide for health technology assessment (HTA) agencies in resource-constrained settings
File(s)
Published online version
Author(s)
Type
Journal Article
Abstract
Understanding the financial and health consequences if economic evaluation assumptions prove incorrect is essential for managing the risk associated with benefit package decisions, particularly in resource-constrained and overburdened healthcare systems. Yet these are also the settings that face the greatest challenges in conducting comprehensive uncertainty analysis, owing to a range of factors including limited skilled staff, data constraints, and short timelines to generate evidence in time to influence policy. This paper takes a pragmatic approach to support health technology assessment agencies in these settings to generate policy-relevant uncertainty analysis, drawing on good practice literature and the authors' collective experience conducting economic evaluation for policy across resource-constrained settings. For each step of the economic evaluation process, we outline the main sources of uncertainty, principles for deciding which uncertainty analysis to prioritise, and approaches to overcome some of the common challenges faced when dealing with constrained timelines, data, and skilled staff. The overarching goal is to support better-informed decisions, by targeting uncertainty analysis to factors that actually affect decisions and by effectively communicating this decision-relevant uncertainty to policymakers.
Understanding the financial and health consequences if economic evaluation assumptions prove incorrect is essential for managing the risk associated with benefit package decisions, particularly in resource-constrained and overburdened healthcare systems. Yet these are also the settings that face the greatest challenges in conducting comprehensive uncertainty analysis, owing to a range of factors including limited skilled staff, data constraints, and short timelines to generate evidence in time to influence policy. This paper takes a pragmatic approach to support health technology assessment agencies in these settings to generate policy-relevant uncertainty analysis, drawing on good practice literature and the authors’ collective experience conducting economic evaluation for policy across resource-constrained settings. For each step of the economic evaluation process, we outline the main sources of uncertainty, principles for deciding which uncertainty analysis to prioritise, and approaches to overcome some of the common challenges faced when dealing with constrained timelines, data, and skilled staff. The overarching goal is to support better-informed decisions, by targeting uncertainty analysis to factors that actually affect decisions and by effectively communicating this decision-relevant uncertainty to policymakers.
Date Issued
2026-07-23
Date Acceptance
2026-07-06
Citation
PharmacoEconomics, 2026
ISSN
1170-7690
Publisher
Springer Science and Business Media LLC
Journal / Book Title
PharmacoEconomics
Copyright Statement
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
License URL
Identifier
10.1007/s40273-026-01645-w
Publication Status
Published online
Date Publish Online
2026-07-23