# A multi-stakeholder survey on communicating cost-effectiveness uncertainties to stakeholders: a case study of ICER

## TL;DR

This study explores how different stakeholders understand and interpret how ICER communicates uncertainties in cost-effectiveness analyses.

## Contribution

The study identifies stakeholder perceptions of ICER's uncertainty communication and highlights areas for improvement.

## Key findings

- Most respondents found sensitivity analyses communicated clearly, but structural and parametric assumptions were less clear.
- Thematic analysis revealed areas for improvement, including scenario analyses and stakeholder-tailored communications.

## Abstract

Cost-effectiveness analyses (CEA) are integral to health technology assessments performed by the US-based Institute for Clinical and Economic Review (ICER). This study aims to examine how stakeholder groups perceive and interpret ICER's communication on uncertainty in CEA findings.

We performed a multi-stakeholder survey among individuals recruited via ICER's weekly update email (March/April 2025). The survey focused on 6 topics related to ICER's uncertainty communication based on the organization's published reference case, consisting of Likert-scale and open-ended questions. Results were analyzed descriptively with thematic analysis of open-ended responses.

Thirty-four responses were collected, representing different stakeholder groups. Results indicated that 16/18 of respondents found sensitivity analyses to be communicated clearly (varying by analysis type), while 9/17 found structural and parametric assumptions to be communicated clearly. Most report sections were understandable respondents, and 15/23 found the communication of uncertainty outside reports to be understandable. Thematic analysis identified scenario analyses, structural/parametric uncertainty communication, and stakeholder-tailored communications as areas for future enhancement.

While methodological guidelines focus on quantifying uncertainty, limited guidance exists for communicating key facts on uncertainty to different stakeholder groups. This study highlights specific stakeholder-perceived areas for improvement. Future research could compare these results to other organizations.