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Adapting portfolio theory for the evaluation of multiple investments in health with a multiplicative extension for treatment synergies

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  • J. F. P. Bridges
  • M. Stewart
  • M. T. King
  • K. van Gool

Abstract

Portfolio theory is central to the analysis of risk in many areas of economics but is seldom used appropriately in health economics. This contribution examines the use of portfolio theory in the context of cost-effectiveness analysis (CEA). A number of modifications are needed to apply portfolio analysis to the economic evaluation of health care interventions. First, the method of reporting the results of a CEA, and consequently some of the underlying assumptions, needs to be modified. Second, portfolio theory needs to be expressed in terms of effects on individuals aggregated to a population. Finally, one needs to allow for the possibility of synergy between the various health interventions. This paper derives a general formula for a portfolio of health care interventions that allows for synergies between interventions where the population effects are aggregated from individual effects. A number of special cases are also derived to highlight the nature of the formulation of the modified portfolio theory. We conclude that, while modified portfolio theory adds a theoretical foundation to health care evaluations, it may not be operational until estimates of the correlation between interventions are available, and the question of uncertainty is resolved in health care evaluation. Also, while a synergy may be present at the individual level, when aggregated over a large population it may not be significant given the standard assumption of constant returns to scale. Copyright Springer-Verlag Berlin Heidelberg 2002

Suggested Citation

  • J. F. P. Bridges & M. Stewart & M. T. King & K. van Gool, 2002. "Adapting portfolio theory for the evaluation of multiple investments in health with a multiplicative extension for treatment synergies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 3(1), pages 47-53, March.
  • Handle: RePEc:spr:eujhec:v:3:y:2002:i:1:p:47-53
    DOI: 10.1007/s10198-001-0090-5
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    Cited by:

    1. Oliver Gao, H. & Stasko, Timon H., 2009. "Diversification in the driveway: mean-variance optimization for greenhouse gas emissions reduction from the next generation of vehicles," Energy Policy, Elsevier, vol. 37(12), pages 5019-5027, December.
    2. E. Michael Foster & Michele M. Porter & Tim S. Ayers & Debra L. Kaplan & Irwin Sandler, 2007. "Estimating the Costs of Preventive Interventions," Evaluation Review, , vol. 31(3), pages 261-286, June.
    3. Dimitrios Bisias & Andrew W Lo & James F Watkins, 2012. "Estimating the NIH Efficient Frontier," PLOS ONE, Public Library of Science, vol. 7(5), pages 1-10, May.
    4. Elamin H. Elbasha, 2005. "Risk aversion and uncertainty in cost‐effectiveness analysis: the expected‐utility, moment‐generating function approach," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 457-470, May.
    5. John Bridges, 2006. "Lean Systems Approaches to Health Technology Assessment," PharmacoEconomics, Springer, vol. 24(2), pages 101-109, December.

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