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Choosing from multiple alternatives in cost-effectiveness analysis with fuzzy willingness-to-pay/accept and uncertainty

Author

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  • Michal Jakubczyk

Abstract

Cost-effectiveness analysis of medical technologies requires valuing health, an uneasy task, as confirmed by variability of published estimates. Treating the willingness-to-pay/accept (WTP/WTA) as fuzzy seems an intuitive solution. Based on this premise, I construct a framework allowing to compare multiple health technologies using choice functions. The final choice must be crisp, so I discuss various defuzzification methods and show that using indecisiveness point (IP) for WTP/WTA (the value the decision maker equally approves/disapproves) has desirable properties: satisfying the independence of irrelevant alternatives and not treating the Likert scale as interval. I suggest three approaches to infer about IP with Likert-based surveys in random samples (hypothesis testing, Bayesian or frequentist estimation). No difference between IPs for WTP/WTA is found, and an explanation of the WTP-WTA disparity is provided. Estimating IP results in stochastic uncertainty, and I show how to conduct sensitivity analysis in the framework and what new insight is gained.

Suggested Citation

  • Michal Jakubczyk, 2016. "Choosing from multiple alternatives in cost-effectiveness analysis with fuzzy willingness-to-pay/accept and uncertainty," Working Papers 2016-006, Warsaw School of Economics, Collegium of Economic Analysis.
  • Handle: RePEc:sgh:kaewps:2016006
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    File URL: http://kolegia.sgh.waw.pl/pl/KAE/Documents/WorkingPapersKAE/WPKAE_2016_006.pdf
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    References listed on IDEAS

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    1. Richard Dykstra & Subhash Kochar & Tim Robertson, 1995. "Likelihood ratio tests for symmetry against one-sided alternatives," Annals of the Institute of Statistical Mathematics, Springer;The Institute of Statistical Mathematics, vol. 47(4), pages 719-730, December.
    2. 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, December.
    3. Zhao, Jinhua & Kling, Catherine L., 2001. "A new explanation for the WTP/WTA disparity," Economics Letters, Elsevier, vol. 73(3), pages 293-300, December.
    4. Viscusi, W Kip & Aldy, Joseph E, 2003. "The Value of a Statistical Life: A Critical Review of Market Estimates throughout the World," Journal of Risk and Uncertainty, Springer, vol. 27(1), pages 5-76, August.
    5. 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, May.
    6. Bellavance, Franois & Dionne, Georges & Lebeau, Martin, 2009. "The value of a statistical life: A meta-analysis with a mixed effects regression model," Journal of Health Economics, Elsevier, vol. 28(2), pages 444-464, March.
    7. Johansson-Stenman, Olof & Svedsäter, Henrik, 2012. "Self-image and valuation of moral goods: Stated versus actual willingness to pay," Journal of Economic Behavior & Organization, Elsevier, vol. 84(3), pages 879-891.
    8. Doucouliagos, Chris & Stanley, T.D. & Giles, Margaret, 2012. "Are estimates of the value of a statistical life exaggerated?," Journal of Health Economics, Elsevier, vol. 31(1), pages 197-206.
    9. repec:reg:rpubli:282 is not listed on IDEAS
    10. Dubourg, W R & Jones-Lee, M W & Loomes, Graham, 1994. "Imprecise Preferences and the WTP-WTA Disparity," Journal of Risk and Uncertainty, Springer, vol. 9(2), pages 115-133, October.
    11. 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.
    12. Garber, Alan M., 2000. "Advances in cost-effectiveness analysis of health interventions," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.),Handbook of Health Economics, edition 1, volume 1, chapter 4, pages 181-221, Elsevier.
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    More about this item

    Keywords

    Willingness-to-pay/accept; Fuzzy sets; Preference elicitation; Cost-effectiveness analysis; Sensitivity analysis;

    JEL classification:

    • C44 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods: Special Topics - - - Operations Research; Statistical Decision Theory
    • C13 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Estimation: General
    • D81 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Criteria for Decision-Making under Risk and Uncertainty
    • D61 - Microeconomics - - Welfare Economics - - - Allocative Efficiency; Cost-Benefit Analysis

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