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Bootstrap confidence intervals for cost‐effectiveness ratios: some simulation results


  • Magnus Tambour
  • Niklas Zethraeus


Recently, a number of papers have brought up the issue of how to make cost‐effectiveness (CE) studies stochastic, i.e. how to obtain confidence intervals for CE ratios. In this note we present a bootstrap procedure for estimating bias‐corrected confidence intervals for CE ratios. The bootstrap procedure is tested in a simulation study based on the assumptions made in a recent paper by Wakker and Klaassen in this journal. We test two variants of CE ratio bootstrap confidence intervals. The first is a bootstrap analogue of the parametric method proposed by Wakker and Klaassen which gives results similar to those obtained with the parametric method. However, computing bootstrap confidence intervals directly for the CE ratio produce results closer to the predetermined significance level. © 1998 John Wiley & Sons, Ltd.

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  • Magnus Tambour & Niklas Zethraeus, 1998. "Bootstrap confidence intervals for cost‐effectiveness ratios: some simulation results," Health Economics, John Wiley & Sons, Ltd., vol. 7(2), pages 143-147, March.
  • Handle: RePEc:wly:hlthec:v:7:y:1998:i:2:p:143-147
    DOI: 10.1002/(SICI)1099-1050(199803)7:2<143::AID-HEC322>3.0.CO;2-Q

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    References listed on IDEAS

    1. Michael Drummond & Bernie O'Brienm, 1993. "Clinical importance, statistical significance and the assessment of economic and quality‐of‐life outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 2(3), pages 205-212, October.
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    Cited by:

    1. Pinto-Prades, Jose Luis & Loomes, Graham & Brey, Raul, 2009. "Trying to estimate a monetary value for the QALY," Journal of Health Economics, Elsevier, vol. 28(3), pages 553-562, May.
    2. Nandita Mitra & Alka Indurkhya, 2005. "A propensity score approach to estimating the cost–effectiveness of medical therapies from observational data," Health Economics, John Wiley & Sons, Ltd., vol. 14(8), pages 805-815, August.
    3. Ernst, Richard, 2017. "Theories of Health Care Cost-Effectiveness Analysis," SocArXiv gjbcp, Center for Open Science.
    4. Feng Xie & Ngai-Nung Lo & Jean-Eric Tarride & Daria O’Reilly & Ron Goeree & Hin-Peng Lee, 2010. "Total or partial knee replacement? Cost-utility analysis in patients with knee osteoarthritis based on a 2-year observational study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(1), pages 27-34, February.
    5. Bo Hsiao & Li-Hsueh Chen, 2019. "Performance Evaluation for Taiwanese Hospitals by Multi-Activity Network Data Envelopment Analysis," International Journal of Information Technology & Decision Making (IJITDM), World Scientific Publishing Co. Pte. Ltd., vol. 18(03), pages 1009-1043, May.
    6. Kobelt, G., 2013. "Health Economics: An Introduction to Economic Evaluation," Monographs, Office of Health Economics, number 000004, January.
    7. Anthony O’Hagan & John Stevens & Jacques Montmartin, 2000. "Inference for the Cost-Effectiveness Acceptability Curve and Cost-Effectiveness Ratio," PharmacoEconomics, Springer, vol. 17(4), pages 339-349, April.
    8. 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, June.

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