Cost-effectiveness acceptability curves - facts, fallacies and frequently asked questions
Cost-effectiveness acceptability curves (CEACs) have been widely adopted as a method to quantify and graphically represent uncertainty in economic evaluation studies of health-care technologies. However, there remain some common fallacies regarding the nature and shape of CEACs that largely result from the 'textbook' illustration of the CEAC. This 'textbook' CEAC shows a smooth curve starting at probability 0, with an asymptote to 1 for higher money values of the health outcome (λ). But this familiar 'ogive' shape which makes the 'textbook' CEAC look like a cumulative distribution function is just one special case of the CEAC. The reality is that the CEAC can take many shapes and turns because it is a graphic transformation from the cost-effectiveness plane, where the joint density of incremental costs and effects may 'straddle' quadrants with attendant discontinuities and asymptotes. In fact CEACs: (i) do not have to cut the y-axis at 0; (ii) do not have to asymptote to 1; (iii) are not always monotonically increasing in λ; and (iv) do not represent cumulative distribution functions (cdfs). Within this paper we present a 'gallery' of CEACs in order to identify the fallacies and illustrate the facts surrounding the CEAC. The aim of the paper is to serve as a reference tool to accompany the increased use of CEACs within major medical journals. Copyright © 2004 John Wiley & Sons, Ltd.
Volume (Year): 13 (2004)
Issue (Month): 5 ()
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References listed on IDEAS
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- Andrew Briggs & Paul Fenn, 1998. "Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane," Health Economics, John Wiley & Sons, Ltd., vol. 7(8), pages 723-740.
- 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.
- Bryan R. Luce & Karl Claxton, 1999. "Redefining the analytical approach to pharmacoeconomics," Health Economics, John Wiley & Sons, Ltd., vol. 8(3), pages 187-189.
- 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.
- Andrew H. Briggs, 1999. "A Bayesian approach to stochastic cost-effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 8(3), pages 257-261.
- Daniel F. Heitjan & Alan J. Moskowitz & William Whang, 1999. "Bayesian estimation of cost-effectiveness ratios from clinical trials," Health Economics, John Wiley & Sons, Ltd., vol. 8(3), pages 191-201.
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