The online version of this article (doi:10.1186/1471-2288-14-39) contains supplementary material, which is available to authorized users.
Anthony Cousien, Dorothée Obach contributed equally to this work.
SDB received grants from Roche, Janssen-Cilag and Schering-Plough and consultancy honoraria from Merck and GlaxoSmithKline. GE received funds from BioGenesic Phasma and BMS. YY received travel grants, honoraria for presentations at workshops and consultancy honoraria from Abbott, Bristol-Myers Squibb, Gilead, Merck, Roche, Tibotec and ViiV Healthcare. None of the other authors report any association that might pose a conflict of interest.
YY had the idea for the study. DO, SBD, VC and YY contributed to the conception and design of the analysis. GE and MKM took part in the selection of experts. GE, MEK, MES, and MKM were part of the panel of experts. AM, DO, and AC performed first-round statistical analysis during the Delphi process. AC performed the second round and additional statistical analysis. All authors contributed to interpretation of data. AC drafted the article and all authors critically revised it for important intellectual content. All authors approved the final version of the manuscript to be published.
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.
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.
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).
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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- Is expert opinion reliable when estimating transition probabilities? The case of HCV-related cirrhosis in Egypt
Mohamed El Kassas
Wagida A Anwar
Mostafa K Mohamed
- BioMed Central
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