IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v7y1998i8p723-740.html
   My bibliography  Save this article

Confidence intervals or surfaces? Uncertainty on the cost‐effectiveness plane

Author

Listed:
  • Andrew Briggs
  • Paul Fenn

Abstract

Although 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.

Suggested Citation

  • 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, December.
  • Handle: RePEc:wly:hlthec:v:7:y:1998:i:8:p:723-740
    DOI: 10.1002/(SICI)1099-1050(199812)7:8<723::AID-HEC392>3.0.CO;2-O
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/(SICI)1099-1050(199812)7:83.0.CO;2-O
    Download Restriction: no

    File URL: https://libkey.io/10.1002/(SICI)1099-1050(199812)7:8<723::AID-HEC392>3.0.CO;2-O?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. Andrew Briggs & Mark Sculpher & Martin Buxton, 1994. "Uncertainty in the economic evaluation of health care technologies: The role of sensitivity analysis," Health Economics, John Wiley & Sons, Ltd., vol. 3(2), pages 95-104, March.
    2. Aaron A. Stinnett & John Mullahy, 1998. "Net Health Benefits," Medical Decision Making, , vol. 18(2_suppl), pages 68-80, April.
    3. Andrew H. Briggs & David E. Wonderling & Christopher Z. Mooney, 1997. "Pulling cost‐effectiveness analysis up by its bootstraps: A non‐parametric approach to confidence interval estimation," Health Economics, John Wiley & Sons, Ltd., vol. 6(4), pages 327-340, July.
    4. Aaron A. Stinnett, 1996. "Adjusting for bias in C/E ratio estimates," Health Economics, John Wiley & Sons, Ltd., vol. 5(5), pages 470-472, September.
    5. Niklas Zethraeus, 1998. "Willingness to pay for hormone replacement therapy," Health Economics, John Wiley & Sons, Ltd., vol. 7(1), pages 31-38, February.
    6. Ben A. Van Hout & Maiwenn J. Al & Gilad S. Gordon & Frans F. H. Rutten, 1994. "Costs, effects and C/E‐ratios alongside a clinical trial," Health Economics, John Wiley & Sons, Ltd., vol. 3(5), pages 309-319, September.
    7. Poole, C., 1987. "Beyond the confidence interval," American Journal of Public Health, American Public Health Association, vol. 77(2), pages 195-199.
    Full references (including those not matched with items on IDEAS)

    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. Andrew Briggs, 2012. "Statistical Methods for Cost-effectiveness Analysis Alongside Clinical Trials," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 50, Edward Elgar Publishing.
    2. Kobelt, G., 2013. "Health Economics: An Introduction to Economic Evaluation," Monographs, Office of Health Economics, number 000004, December.
    3. Karl Claxton & Elisabeth Fenwick & Mark J. Sculpher, 2012. "Decision-making with Uncertainty: The Value of Information," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 51, Edward Elgar Publishing.
    4. John Mullahy, 2017. "Individual Results May Vary: Elementary Analytics of Inequality-Probability Bounds, with Applications to Health-Outcome Treatment Effects," NBER Working Papers 23603, National Bureau of Economic Research, Inc.
    5. 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, July.
    6. 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, February.
    7. Janne Martikainen & Hannu Valtonen & Tuula Pirttilä, 2004. "Potential cost-effectiveness of a family-based program in mild Alzheimer’s disease patients," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(2), pages 136-142, May.
    8. Joanne Lord & Maxwell A. Asante, 1999. "Estimating uncertainty ranges for costs by the bootstrap procedure combined with probabilistic sensitivity analysis," Health Economics, John Wiley & Sons, Ltd., vol. 8(4), pages 323-333, June.
    9. Danielle Brunenberg & Gwenn Wetzels & Patricia Nelemans & Carmen Dirksen & Johan Severens & Henri Stoffers & Jan Schouten & Martin Prins & Peter Leeuw & Manuela Joore, 2007. "Cost Effectiveness of an Adherence-Improving Programme in Hypertensive Patients," PharmacoEconomics, Springer, vol. 25(3), pages 239-251, March.
    10. Daniel F. Heitjan, 2000. "Fieller's method and net health benefits," Health Economics, John Wiley & Sons, Ltd., vol. 9(4), pages 327-335, June.
    11. Ana P. Johnson-Masotti & Purushottam W. Laud & Raymond G. Hoffmann & Matthew J. Hayat & Steven D. Pinkerton, 2001. "Probabilistic Cost-Effectiveness Analysis of HIV Prevention," Evaluation Review, , vol. 25(4), pages 474-502, August.
    12. Andrew Briggs & Mark Sculpher, 1995. "Sensitivity analysis in economic evaluation: A review of published studies," Health Economics, John Wiley & Sons, Ltd., vol. 4(5), pages 355-371, September.
    13. 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.
    14. Bas Groot Koerkamp & Milton C. Weinstein & Theo Stijnen & M.H. Heijenbrok-Kal & M.G. Myriam Hunink, 2010. "Uncertainty and Patient Heterogeneity in Medical Decision Models," Medical Decision Making, , vol. 30(2), pages 194-205, March.
    15. David Meads & Andrea Marshall & Claire Hulme & Janet Dunn & Hugo Ford, 2016. "The Cost Effectiveness of Docetaxel and Active Symptom Control versus Active Symptom Control Alone for Refractory Oesophagogastric Adenocarcinoma: Economic Analysis of the COUGAR-02 Trial," PharmacoEconomics, Springer, vol. 34(1), pages 33-42, January.
    16. Andrew R. Willan & Bernie J. O'Brien, 1999. "Sample size and power issues in estimating incremental cost‐effectiveness ratios from clinical trials data," Health Economics, John Wiley & Sons, Ltd., vol. 8(3), pages 203-211, May.
    17. Edmond S.-W. Ng & Richard Grieve & James R. Carpenter, 2013. "Two-stage nonparametric bootstrap sampling with shrinkage correction for clustered data," Stata Journal, StataCorp LP, vol. 13(1), pages 141-164, March.
    18. Manuel Antonio Espinoza & Andrea Manca & Karl Claxton & Mark Sculpher, 2018. "Social value and individual choice: The value of a choice‐based decision‐making process in a collectively funded health system," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 28-40, February.
    19. A. E. Ades & Karl Claxton & Mark Sculpher, 2006. "Evidence synthesis, parameter correlation and probabilistic sensitivity analysis," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 373-381, April.
    20. Iris Arends & Ute Bültmann & Willem van Rhenen & Henk Groen & Jac J L van der Klink, 2013. "Economic Evaluation of a Problem Solving Intervention to Prevent Recurrent Sickness Absence in Workers with Common Mental Disorders," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-1, August.

    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:wly:hlthec:v:7:y:1998:i:8:p:723-740. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    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: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

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

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.