The Assessment of the Validation Status of Health-Economic decision models (AdViSHE), first published in 2016, was developed in response to the critical need for an efficient and transparent approach to validating health economic (HE) models that reinforce crucial decision-making in healthcare. In the multifaceted landscape of health policy, resource allocation, and reimbursement decisions, HE models play a key role in predicting the costs and consequences of interventions. Although these models are powerful, their value relies on how much decision makers trust their predictions. Therefore, ensuring their credibility is important.(1, 2)

Through systematic documentation and structured reporting, AdViSHE facilitates accurate representation of the HE model validation activities and their outcomes. This transparency further enables model users, including decision makers, peer reviewers, or health technology assessment (HTA) bodies, to easily and efficiently evaluate both the appropriateness of validation and the need for additional steps, thus avoiding redundant efforts.(1-3)

AdViSHE extensively covers 13 key items across the full spectrum of validation, including the conceptual bases of the model, the quality and reliability of input data, the accuracy of the software operation, and the model’s output credibility.(3) Every item is supported by established best practices and collaborative expert consensus, providing the basis for good validation standards. With this, AdViSHE not only improves trust and transparency for decision makers, but also facilitates model developers to achieve higher standards of methodological rigor.(1-3)

Practically speaking, AdViSHE supports the preparation and submission of HE models for reimbursement applications, enables peer review of modelling studies, and improves communication between developers and users. By supporting reproducibility and streamlining validation efforts, the tool supports efficient resource allocation while minimizing duplication of efforts. It is being increasingly cited across multiple national guidelines, which shows its growing acceptance and incorporation into the larger health economics community.(1, 2)

However, there are several persistent gaps in the validation and reporting of HE models. Despite the availability of AdViSHE, a 2025 systematic review showed severe lack of improvement in reporting practices over the past decade. While expert validation of input data is slightly more common today, crucial steps like conceptual model validation and computerized model validation remain hugely ignored, with only about 10% and less than 4% of studies, respectively, addressing these gaps. Outcome cross-validation against empirical data is still the most commonly reported category, but often paired with incomplete documentation lacking in systematic detail.(4) A 2024 editorial further highlights the urgent need of strengthening the validation, showing how the growing difficulty of models, influenced by real-world data (RWD), open-source platforms, and machine learning (ML) methods, necessitates more robust and transparent practices. Although tools like AdViSHE offer a minimum standard, their adoption is still inconsistent, and future steps warrant clearer guidelines with more comprehensive reporting.(5)

To conclude, AdViSHE is more than a technical checklist as it bridges the gap between multifaceted modelling processes and the real-world decisions affecting patients and healthcare systems. By supporting transparency, credibility, and shared understanding, it facilitates the evolution of HE models from sophisticated analytical tools to trusted, decision-ready channels that can help design healthcare policies and practices.

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References

1. AdViSHE – Assessment of the Validation Status of Health Economic decision models. [Accessed on 13^th Sep 2025]. Available at: https://advishe.wordpress.com
2. Vemer P, Corro Ramos I, van Voorn GA, Al MJ, Feenstra TL. AdViSHE: A Validation-Assessment Tool of Health-Economic Models for Decision Makers and Model Users. Pharmacoeconomics. 2016 Apr;34(4):349-61.
3. Feenstra TL. ADVISHE. Reporting Tool+ Website. 2020. [Accessed on 13^th Sep 2025]. Available at: https://research.rug.nl/en/publications/advishe-reporting-tool-website
4. Abraham K, Corro Ramos I, Braal CL, Feenstra T, Kleijburg A, van Voorn GAK, Uyl-de Groot C. Under-reporting of Validation Efforts for Health Economic Models Persists Despite the Availability of Validation Tools: A Systematic Review. Pharmacoeconomics. 2025 Aug;43(8):849-858.
5. Corro Ramos I, Feenstra T, Ghabri S, Al M. Evaluating the Validation Process: Embracing Complexity and Transparency in Health Economic Modelling. Pharmacoeconomics. 2024 Jul;42(7):715-719.