IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0115544.html
   My bibliography  Save this article

Better Informing Decision Making with Multiple Outcomes Cost-Effectiveness Analysis under Uncertainty in Cost-Disutility Space

Author

Listed:
  • Nikki McCaffrey
  • Meera Agar
  • Janeane Harlum
  • Jonathon Karnon
  • David Currow
  • Simon Eckermann

Abstract

Introduction: Comparing multiple, diverse outcomes with cost-effectiveness analysis (CEA) is important, yet challenging in areas like palliative care where domains are unamenable to integration with survival. Generic multi-attribute utility values exclude important domains and non-health outcomes, while partial analyses—where outcomes are considered separately, with their joint relationship under uncertainty ignored—lead to incorrect inference regarding preferred strategies. Objective: The objective of this paper is to consider whether such decision making can be better informed with alternative presentation and summary measures, extending methods previously shown to have advantages in multiple strategy comparison. Methods: Multiple outcomes CEA of a home-based palliative care model (PEACH) relative to usual care is undertaken in cost disutility (CDU) space and compared with analysis on the cost-effectiveness plane. Summary measures developed for comparing strategies across potential threshold values for multiple outcomes include: expected net loss (ENL) planes quantifying differences in expected net benefit; the ENL contour identifying preferred strategies minimising ENL and their expected value of perfect information; and cost-effectiveness acceptability planes showing probability of strategies minimising ENL. Results: Conventional analysis suggests PEACH is cost-effective when the threshold value per additional day at home (1) exceeds $1,068 or dominated by usual care when only the proportion of home deaths is considered. In contrast, neither alternative dominate in CDU space where cost and outcomes are jointly considered, with the optimal strategy depending on threshold values. For example, PEACH minimises ENL when 1=$2,000 and 2=$2,000 (threshold value for dying at home), with a 51.6% chance of PEACH being cost-effective. Conclusion: Comparison in CDU space and associated summary measures have distinct advantages to multiple domain comparisons, aiding transparent and robust joint comparison of costs and multiple effects under uncertainty across potential threshold values for effect, better informing net benefit assessment and related reimbursement and research decisions.

Suggested Citation

  • Nikki McCaffrey & Meera Agar & Janeane Harlum & Jonathon Karnon & David Currow & Simon Eckermann, 2015. "Better Informing Decision Making with Multiple Outcomes Cost-Effectiveness Analysis under Uncertainty in Cost-Disutility Space," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-19, March.
    • Handle: RePEc:plo:pone00:0115544
    DOI: 10.1371/journal.pone.0115544
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0115544
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0115544&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0115544?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Jakob Bjørner & Hans Keiding, 2004. "Cost‐effectiveness with multiple outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 13(12), pages 1181-1190, December.
    2. Birch, Stephen & Gafni, Amiram, 1992. "Cost effectiveness/utility analyses : Do current decision rules lead us to where we want to be?," Journal of Health Economics, Elsevier, vol. 11(3), pages 279-296, October.
    3. Eckermann, Simon & Dawber, James & Yeatman, Heather & Quinsey, Karen & Morris, Darcy, 2014. "Evaluating return on investment in a school based health promotion and prevention program: The investment multiplier for the Stephanie Alexander Kitchen Garden National Program," Social Science & Medicine, Elsevier, vol. 114(C), pages 103-112.
    4. Aaron A. Stinnett & John Mullahy, 1998. "Net Health Benefits," Medical Decision Making, , vol. 18(2_suppl), pages 68-80, April.
    5. Simon Eckermann & Andrew Willan, 2011. "Presenting Evidence and Summary Measures to Best Inform Societal Decisions When Comparing Multiple Strategies," PharmacoEconomics, Springer, vol. 29(7), pages 563-577, July.
    6. Simon Eckermann & Andrew Briggs & Andrew R. Willan, 2008. "Health Technology Assessment in the Cost-Disutility Plane," Medical Decision Making, , vol. 28(2), pages 172-181, March.
    7. Andrew H. Briggs & Bernie J. O'Brien, 2001. "The death of cost‐minimization analysis?," Health Economics, John Wiley & Sons, Ltd., vol. 10(2), pages 179-184, March.
    8. Niklas Zethraeus & Magnus Johannesson & Bengt Jönsson & Mickael Löthgren & Magnus Tambour, 2003. "Advantages of Using the Net-Benefit Approach for Analysing Uncertainty in Economic Evaluation Studies," PharmacoEconomics, Springer, vol. 21(1), pages 39-48, January.
    9. Kenneth J. Arrow & Robert C. Lind, 1974. "Uncertainty and the Evaluation of Public Investment Decisions," Palgrave Macmillan Books, in: Chennat Gopalakrishnan (ed.), Classic Papers in Natural Resource Economics, chapter 3, pages 54-75, Palgrave Macmillan.
    10. Aaron A. Stinnett & John Mullahy, 1998. "Net Health Benefits: A New Framework for the Analysis of Uncertainty in Cost-Effectiveness Analysis," NBER Technical Working Papers 0227, National Bureau of Economic Research, Inc.
    11. Simon Eckermann & Andrew R. Willan, 2007. "Expected value of information and decision making in HTA," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 195-209, February.
    12. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    13. Hawe, Penelope & Shiell, Alan, 2000. "Social capital and health promotion: a review," Social Science & Medicine, Elsevier, vol. 51(6), pages 871-885, September.
    14. Simon Eckermann & Brita Pekarsky, 2014. "Can the Real Opportunity Cost Stand Up: Displaced Services, the Straw Man Outside the Room," PharmacoEconomics, Springer, vol. 32(4), pages 319-325, April.
    15. Jeffrey Hoch & Carolyn Dewa, 2007. "Lessons from Trial-Based Cost-Effectiveness Analyses of Mental Health Interventions," PharmacoEconomics, Springer, vol. 25(10), pages 807-816, October.
    16. Eckermann, Simon & Coelli, Tim, 2013. "Including quality attributes in efficiency measures consistent with net benefit: Creating incentives for evidence based medicine in practice," Social Science & Medicine, Elsevier, vol. 76(C), pages 159-168.
    17. Bas Groot Koerkamp & M.G. Myriam Hunink & Theo Stijnen & James K. Hammitt & Karen M. Kuntz & Milton C. Weinstein, 2007. "Limitations of Acceptability Curves for Presenting Uncertainty in Cost-Effectiveness Analysis," Medical Decision Making, , vol. 27(2), pages 101-111, March.
    18. Hareth Al-Janabi & Terry Flynn & Joanna Coast, 2011. "QALYs and Carers," PharmacoEconomics, Springer, vol. 29(12), pages 1015-1023, December.
    19. Andrew Willan & Simon Eckermann, 2012. "Value of Information and Pricing New Healthcare Interventions," PharmacoEconomics, Springer, vol. 30(6), pages 447-459, June.
    20. Hareth Al-Janabi & Nikki McCaffrey & Julie Ratcliffe, 2013. "Carer Preferences in Economic Evaluation and Healthcare Decision Making," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 6(4), pages 235-239, December.
    21. A. Shiell & P. Hawe, 1996. "Health promotion community development and the tyranny of individualism," Health Economics, John Wiley & Sons, Ltd., vol. 5(3), pages 241-247, May.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Noah J Miller & Jason S Bergtold & Allen M Featherstone, 2019. "Economic elasticities of input substitution using data envelopment analysis," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-15, August.
    2. Lukasz Tanajewski & Matthew Franklin & Georgios Gkountouras & Vladislav Berdunov & Rowan H Harwood & Sarah E Goldberg & Lucy E Bradshaw & John R F Gladman & Rachel A Elliott, 2015. "Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial)," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-20, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Eckermann, Simon & Coelli, Tim, 2013. "Including quality attributes in efficiency measures consistent with net benefit: Creating incentives for evidence based medicine in practice," Social Science & Medicine, Elsevier, vol. 76(C), pages 159-168.
    2. Helen Dakin & Sarah Wordsworth, 2013. "Cost‐Minimisation Analysis Versus Cost‐Effectiveness Analysis, Revisited," Health Economics, John Wiley & Sons, Ltd., vol. 22(1), pages 22-34, January.
    3. Elamin H. Elbasha, 2005. "Risk aversion and uncertainty in cost‐effectiveness analysis: the expected‐utility, moment‐generating function approach," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 457-470, May.
    4. Hoch, Jeffrey S. & Blume, Jeffrey D., 2008. "Measuring and illustrating statistical evidence in a cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 27(2), pages 476-495, March.
    5. Simon Eckermann & Andrew Willan, 2011. "Presenting Evidence and Summary Measures to Best Inform Societal Decisions When Comparing Multiple Strategies," PharmacoEconomics, Springer, vol. 29(7), pages 563-577, July.
    6. Simon Eckermann & Andrew R. Willan, 2009. "Globally optimal trial design for local decision making," Health Economics, John Wiley & Sons, Ltd., vol. 18(2), pages 203-216, February.
    7. Jeffrey Hoch & Carolyn Dewa, 2007. "Lessons from Trial-Based Cost-Effectiveness Analyses of Mental Health Interventions," PharmacoEconomics, Springer, vol. 25(10), pages 807-816, October.
    8. Sennen Hounton & David Newlands, 2012. "Applying the Net-Benefit Framework for Analyzing and Presenting Cost-Effectiveness Analysis of a Maternal and Newborn Health Intervention," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-8, July.
    9. Simon Eckermann & Andrew R. Willan, 2016. "Expected Value of Sample Information with Imperfect Implementation," Medical Decision Making, , vol. 36(3), pages 282-283, April.
    10. Simon Eckermann & Tim Coelli, 2008. "Including quality attributes in a model of health care efficiency: A net benefit approach," CEPA Working Papers Series WP032008, School of Economics, University of Queensland, Australia.
    11. Frank G. Sandmann & Julie V. Robotham & Sarah R. Deeny & W. John Edmunds & Mark Jit, 2018. "Estimating the opportunity costs of bed‐days," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 592-605, March.
    12. Emma McIntosh, 2006. "Using Discrete Choice Experiments within a Cost-Benefit Analysis Framework," PharmacoEconomics, Springer, vol. 24(9), pages 855-868, September.
    13. Claire McKenna & Karl Claxton, 2011. "Addressing Adoption and Research Design Decisions Simultaneously," Medical Decision Making, , vol. 31(6), pages 853-865, November.
    14. Nicholas Graves & Mary Courtney & Helen Edwards & Anne Chang & Anthony Parker & Kathleen Finlayson, 2009. "Cost-Effectiveness of an Intervention to Reduce Emergency Re-Admissions to Hospital among Older Patients," PLOS ONE, Public Library of Science, vol. 4(10), pages 1-9, October.
    15. Casey Quinn, 2005. "Generalisable regression methods for costeffectiveness using copulas," Health, Econometrics and Data Group (HEDG) Working Papers 05/13, HEDG, c/o Department of Economics, University of York.
    16. Lynch, Frances L. & Dickerson, John F. & Pears, Katherine C. & Fisher, Philip A., 2017. "Cost effectiveness of a school readiness intervention for foster children," Children and Youth Services Review, Elsevier, vol. 81(C), pages 63-71.
    17. Meltzer, David, 2001. "Addressing uncertainty in medical cost-effectiveness analysis: Implications of expected utility maximization for methods to perform sensitivity analysis and the use of cost-effectiveness analysis to s," Journal of Health Economics, Elsevier, vol. 20(1), pages 109-129, January.
    18. Nicola E Stanczyk & Eline S Smit & Daniela N Schulz & Hein de Vries & Catherine Bolman & Jean W M Muris & Silvia M A A Evers, 2014. "An Economic Evaluation of a Video- and Text-Based Computer-Tailored Intervention for Smoking Cessation: A Cost-Effectiveness and Cost-Utility Analysis of a Randomized Controlled Trial," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-14, October.
    19. Falk Schwendicke & Hendrik Meyer-Lueckel & Michael Stolpe & Christof Edmund Dörfer & Sebastian Paris, 2014. "Costs and Effectiveness of Treatment Alternatives for Proximal Caries Lesions," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-10, January.
    20. Helen Dakin & Morris Sherman & Scott Fung & Carrie Fidler & Anthony Bentley, 2011. "Cost Effectiveness of Tenofovir Disoproxil Fumarate for the Treatment of Chronic Hepatitis B from a Canadian Public Payer Perspective," PharmacoEconomics, Springer, vol. 29(12), pages 1075-1091, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0115544. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.