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.

Authors

Siobhan Botwright, Syarifah Liza Munira, Itamar Megiddo, Nouran El Desouky, Lucky Gift Ngwira, Hugo C. Turner & Yot Teerawattananon

Acknowledgements

The Health Intervention and Technology Assessment Program (HITAP) Foundation, based in Thailand, supports evidence-informed priority-setting and decision-making for healthcare. HITAP is funded by national and international public funding agencies.

Funding

This study was funded by the National Science, Research and Innovation Fund (NSRF) through the Program Management Unit for Human Resources & Institutional Development, Research and Innovation [B41G670025 & B41G680024]. The funders had no role in the design, data collection, analysis, interpretation, or writing of the report. HCT acknowledges funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union.

Open access: https://link.springer.com/article/10.1007/s40273-026-01645-w