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. 2014 Mar 17:14:39.
doi: 10.1186/1471-2288-14-39.

Is expert opinion reliable when estimating transition probabilities? The case of HCV-related cirrhosis in Egypt

Anthony Cousien  1 , Dorothée Obach, Sylvie Deuffic-Burban, Aya Mostafa, Gamal Esmat, Valérie Canva, Mohamed El Kassas, Mohammad El-Sayed, Wagida A Anwar, Arnaud Fontanet, Mostafa K Mohamed, Yazdan Yazdanpanah
Affiliations

Is expert opinion reliable when estimating transition probabilities? The case of HCV-related cirrhosis in Egypt

Anthony Cousien et al. BMC Med Res Methodol. .

Abstract

Background: Data on HCV-related cirrhosis progression are scarce in developing countries in general, and in Egypt in particular. The objective of this study was to estimate the probability of death and transition between different health stages of HCV (compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma) for an Egyptian population of patients with HCV-related cirrhosis.

Methods: We used the "elicitation of expert opinions" method to obtain collective knowledge from a panel of 23 Egyptian experts (among whom 17 were hepatologists or gastroenterologists and 2 were infectiologists). The questionnaire was based on virtual medical cases and asked the experts to assess probability of death or probability of various cirrhosis complications. The design was a Delphi study: we attempted to obtain a consensus between experts via a series of questionnaires interspersed with group response feedback.

Results: We found substantial disparity between experts' answers, and no consensus was reached at the end of the process. Moreover, we obtained high death probability and high risk of hepatocellular carcinoma. The annual transition probability to death was estimated at between 10.1% and 61.5% and the annual probability of occurrence of hepatocellular carcinoma was estimated at between 16.8% and 58.9% (depending on age, gender, time spent in cirrhosis and cirrhosis severity).

Conclusions: Our results show that eliciting expert opinions is not suited for determining the natural history of diseases due to practitioners' difficulties in evaluating quantities. Cognitive bias occurring during this type of study might explain our results.

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Figures

Figure 1
Figure 1
Mean estimation of transition probabilities by round for men (a) and women (b). Questions are ranked by current stage, transition stage and age. Corresponding questions are found in Table 1.
Figure 2
Figure 2
Scatter plot of individual transition probability estimates after the second round of Delphi for men (a) and women (b). Corresponding questions are found in Table 1.
Figure 3
Figure 3
Mean probability of transition at the end of the second round for men (a) and women (b) by age group. White circles represent ≥40 age group and black dots represent the <40 age group.
See this image and copyright information in PMC

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