Non-parametric methods for cost-effectiveness analysis: the central limit theorem and the bootstrap compared
Cost-effectiveness analyses (CEA) alongside randomised controlled trials commonly estimate incremental net benefits (INB), with 95% confidence intervals, and compute cost-effectiveness acceptability curves and confidence ellipses. Two alternative non-parametric methods for estimating INB are to apply the central limit theorem (CLT) or to use the non-parametric bootstrap method, although it is unclear which method is preferable. This paper describes the statistical rationale underlying each of these methods and illustrates their application with a trial-based CEA. It compares the sampling uncertainty from using either technique in a Monte Carlo simulation. The experiments are repeated varying the sample size and the skewness of costs in the population. The results showed that, even when data were highly skewed, both methods accurately estimated the true standard errors (SEs) when sample sizes were moderate to large (n>50), and also gave good estimates for small data sets with low skewness. However, when sample sizes were relatively small and the data highly skewed, using the CLT rather than the bootstrap led to slightly more accurate SEs. We conclude that while in general using either method is appropriate, the CLT is easier to implement, and provides SEs that are at least as accurate as the bootstrap. Copyright © 2009 John Wiley & Sons, Ltd.
Volume (Year): 19 (2010)
Issue (Month): 3 ()
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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.
- Anthony O'Hagan & John W. Stevens, 2003. "Assessing and comparing costs: how robust are the bootstrap and methods based on asymptotic normality?," Health Economics, John Wiley & Sons, Ltd., vol. 12(1), pages 33-49.
- Nicola J. Cooper & Alex J. Sutton & Keith R. Abrams & David Turner & Allan Wailoo, 2004. "Comprehensive decision analytical modelling in economic evaluation: a Bayesian approach," Health Economics, John Wiley & Sons, Ltd., vol. 13(3), pages 203-226.
- 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.
- Andrew Briggs & Richard Nixon & Simon Dixon & Simon Thompson, 2005. "Parametric modelling of cost data: some simulation evidence," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 421-428.
- Mark J. Sculpher & Karl Claxton & Mike Drummond & Chris McCabe, 2006. "Whither trial-based economic evaluation for health care decision making?," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 677-687.
- Tambour, Magnus & Zethraeus, Niklas & Johannesson, Magnus, 1997. "A Note on Confidence Intervals in Cost-Effectiveness Analysis," SSE/EFI Working Paper Series in Economics and Finance 181, Stockholm School of Economics.
- Glick, Henry A & Doshi, Jalpa A & Sonnad, Seema S & Polsky, Daniel, 2007. "Economic Evaluation in Clinical Trials," OUP Catalogue, Oxford University Press, number 9780198529972, July.
- 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.
- Daniel F. Heitjan, 2000. "Fieller's method and net health benefits," Health Economics, John Wiley & Sons, Ltd., vol. 9(4), pages 327-335.
- 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.
- Anthony O'Hagan & John W. Stevens, 2001. "A framework for cost-effectiveness analysis from clinical trial data," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 303-315.
- 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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