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

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.