Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane
AbstractAlthough cost-effectiveness analysis is not new, it is only recently that economic analysis has been conducted alongside clinical trials. Whereas in the past economic analysts most often used sensitivity analysis to examine the implications of uncertainty for their results, the existence of patient-level data on costs and effects opens up the possibility of statistical analysis of uncertainty. Unfortunately, ratio statistics can cause problems for standard statistical methods of confidence interval estimation. The recent health economics literature contains a number of suggestions for estimating confidence limits for ratios. In this paper, we begin by reviewing the different methods of confidence interval estimation with a view to providing guidance concerning the most appropriate method. We go on to argue that the focus on confidence interval estimation for cost-effectiveness ratios in the recent literature has been concerned more with problems of estimation than with problems of decision-making. We argue that decision-makers are most likely to be interested in one-sided tests of hypothesis and that confidence surfaces are better suited to such tests than confidence intervals. This approach is consistent with decision-making on the cost-effectiveness plane and with the cost-effectiveness acceptability curve approach to presenting uncertainty due to sampling variation in stochastic cost-effectiveness analyses. Copyright © 1998 John Wiley & Sons, Ltd.
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Bibliographic InfoArticle provided by John Wiley & Sons, Ltd. in its journal Health Economics.
Volume (Year): 7 (1998)
Issue (Month): 8 ()
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- Raymond C.W. Hutubessy & Rob M.P.M. Baltussen & David B. Evans & Jan J. Barendregt & Christopher J.L. Murray, 2001. "Stochastic league tables: communicating cost-effectiveness results to decision-makers," Health Economics, John Wiley & Sons, Ltd., vol. 10(5), pages 473-477.
- Maureen Rutten-van Mölken & Jan Oostenbrink & Marc Miravitlles & Brigitta Monz, 2007. "Modelling the 5-year cost effectiveness of tiotropium, salmeterol and ipratropium for the treatment of chronic obstructive pulmonary disease in Spain," The European Journal of Health Economics, Springer, vol. 8(2), pages 123-135, June.
- Jack Dowie, 2004. "Why cost-effectiveness should trump (clinical) effectiveness: the ethical economics of the South West quadrant," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 453-459.
- N. Neymark & I. Adriaenssen & T. Gorlia & S. Caleo & M. Bolla, 2002. "Estimating survival gain for economic evaluations with survival time as principal endpoint: A cost-effectiveness analysis of adding early hormonal therapy to radiotherapy in patients with locally adva," Health Economics, John Wiley & Sons, Ltd., vol. 11(3), pages 233-248.
- O'Neill, Donal, 2009. "A Cost-Benefit Analysis of Early Childhood Intervention: Evidence from a Randomised Evaluation of a Parenting Programme," IZA Discussion Papers 4518, Institute for the Study of Labor (IZA).
- C. Sabariego & M. Brach & P. Herschbach & P. Berg & G. Stucki, 2011. "Cost-effectiveness of cognitive-behavioral group therapy for dysfunctional fear of progression in cancer patients," The European Journal of Health Economics, Springer, vol. 12(5), pages 489-497, October.
- Elisabeth Fenwick & Karl Claxton & Mark Sculpher, 2001. "Representing uncertainty: the role of cost-effectiveness acceptability curves," Health Economics, John Wiley & Sons, Ltd., vol. 10(8), pages 779-787.
- Maiwenn J. Al & Ben A. Van Hout, 2000. "A Bayesian approach to economic analyses of clinical trials: the case of stenting versus balloon angioplasty," Health Economics, John Wiley & Sons, Ltd., vol. 9(7), pages 599-609.
- Manca, A & Austin, P. C, 2008. "Using propensity score methods to analyse individual patient-level cost-effectiveness data from observational studies," Health, Econometrics and Data Group (HEDG) Working Papers 08/20, HEDG, c/o Department of Economics, University of York.
- Andrew H. Briggs, 1999. "A Bayesian approach to stochastic cost-effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 8(3), pages 257-261.
- Mickael Löthgren & Niklas Zethraeus, 2000. "Definition, interpretation and calculation of cost-effectiveness acceptability curves," Health Economics, John Wiley & Sons, Ltd., vol. 9(7), pages 623-630.
- 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.
- P. Sendi & A. Gafni & S. Birch, 2002. "Opportunity costs and uncertainty in the economic evaluation of health care interventions," Health Economics, John Wiley & Sons, Ltd., vol. 11(1), pages 23-31.
- Shiell, Alan & Rush, Bonnie, 2003. "Can willingness to pay capture the value of altruism? An exploration of Sen's notion of commitment," The Journal of Socio-Economics, Elsevier, vol. 32(6), pages 647-660, December.
- 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.
- 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.
- 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.
- Daniel F. Heitjan & Huiling Li, 2004. "Bayesian estimation of cost-effectiveness: an importance-sampling approach," Health Economics, John Wiley & Sons, Ltd., vol. 13(2), pages 191-198.
- Elisabeth Fenwick & Bernie J. O'Brien & Andrew Briggs, 2004. "Cost-effectiveness acceptability curves - facts, fallacies and frequently asked questions," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 405-415.
- Jeffrey S. Hoch & Andrew H. Briggs & Andrew R. Willan, 2002. "Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 415-430.
- Daniel F. Heitjan, 2000. "Fieller's method and net health benefits," Health Economics, John Wiley & Sons, Ltd., vol. 9(4), pages 327-335.
- Elizabeth Fenwick & Karl Claxton & Mark Sculpher & Andrew Briggs, 2000. "Improving the efficiency and relevance of health technology assessent: the role of iterative decision analytic modelling," Working Papers 179chedp, Centre for Health Economics, University of York.
- F. J. Vázquez-Polo & M. A. Negr�n Hernández & B. González López-Valcárcel, 2005. "Using covariates to reduce uncertainty in the economic evaluation of clinical trial data," Health Economics, John Wiley & Sons, Ltd., vol. 14(6), pages 545-557.
- Richard M. Nixon & David Wonderling & Richard D. Grieve, 2010. "Non-parametric methods for cost-effectiveness analysis: the central limit theorem and the bootstrap compared," Health Economics, John Wiley & Sons, Ltd., vol. 19(3), pages 316-333.
- Andrew R. Willan & Andrew H. Briggs & Jeffrey S. Hoch, 2004. "Regression methods for covariate adjustment and subgroup analysis for non-censored cost-effectiveness data," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 461-475.
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