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Bayesian estimation of cost‐effectiveness ratios from clinical trials

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  • Daniel F. Heitjan
  • Alan J. Moskowitz
  • William Whang

Abstract

Estimation of the incremental cost‐effectiveness ratio (ICER) is difficult for several reasons: treatments that decrease both cost and effectiveness and treatments that increase both cost and effectiveness can yield identical values of the ICER; the ICER is a discontinuous function of the mean difference in effectiveness; and the standard estimate of the ICER is a ratio. To address these difficulties, we have developed a Bayesian methodology that involves computing posterior probabilities for the four quadrants and separate interval estimates of ICER for the quadrants of interest. We compute these quantities by simulating draws from the posterior distribution of the cost and effectiveness parameters and tabulating the appropriate posterior probabilities and quantiles. We demonstrate the method by re‐analysing three previously published clinical trials. Copyright © 1999 John Wiley & Sons, Ltd.

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  • Daniel F. Heitjan & Alan J. Moskowitz & William Whang, 1999. "Bayesian estimation of cost‐effectiveness ratios from clinical trials," Health Economics, John Wiley & Sons, Ltd., vol. 8(3), pages 191-201, May.
    • Handle: RePEc:wly:hlthec:v:8:y:1999:i:3:p:191-201
    DOI: 10.1002/(SICI)1099-1050(199905)8:3<191::AID-HEC409>3.0.CO;2-R
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    References listed on IDEAS

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    1. Daniel Polsky & Henry A. Glick & Richard Willke & Kevin Schulman, 1997. "Confidence Intervals for Cost–Effectiveness Ratios: A Comparison of Four Methods," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 243-252, May.
    2. Daniel F. Heitjan, 2000. "Fieller's method and net health benefits," Health Economics, John Wiley & Sons, Ltd., vol. 9(4), pages 327-335, June.
    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. Eugene M. Laska & Morris Meisner & Carole Siegel, 1997. "Statistical Inference for Cost–Effectiveness Ratios," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 229-242, May.
    5. Daniel F. Heitjan & Alan J. Moskowitz & William Whang, 1999. "Problems with Interval Estimates of the Incremental Cost—Effectiveness Ratio," Medical Decision Making, , vol. 19(1), pages 9-15, January.
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    Cited by:

    1. Negri­n, Miguel A. & Vázquez-Polo, Francisco-José, 2008. "Incorporating model uncertainty in cost-effectiveness analysis: A Bayesian model averaging approach," Journal of Health Economics, Elsevier, vol. 27(5), pages 1250-1259, September.
    2. Niklas Zethraeus & Magnus Johannesson & Bengt Jönsson & Mickael Löthgren & Magnus Tambour, 2003. "Advantages of Using the Net-Benefit Approach for Analysing Uncertainty in Economic Evaluation Studies," PharmacoEconomics, Springer, vol. 21(1), pages 39-48, January.
    3. Mickael Löthgren & Niklas Zethraeus, 2000. "Definition, interpretation and calculation of cost‐effectiveness acceptability curves," Health Economics, John Wiley & Sons, Ltd., vol. 9(7), pages 623-630, October.
    4. P. Sendi & A. Gafni & S. Birch, 2002. "Opportunity costs and uncertainty in the economic evaluation of health care interventions," Health Economics, John Wiley & Sons, Ltd., vol. 11(1), pages 23-31, January.
    5. Carmen Selva-Sevilla & F Dámaso Fernández-Ginés & Manuel Cortiñas-Sáenz & Manuel Gerónimo-Pardo, 2021. "Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-18, September.
    6. Maiwenn J. Al & Ben A. Van Hout, 2000. "A Bayesian approach to economic analyses of clinical trials: the case of stenting versus balloon angioplasty," Health Economics, John Wiley & Sons, Ltd., vol. 9(7), pages 599-609, October.
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    8. N. Neymark & I. Adriaenssen & T. Gorlia & S. Caleo & M. Bolla, 2002. "Estimating survival gain for economic evaluations with survival time as principal endpoint: A cost‐effectiveness analysis of adding early hormonal therapy to radiotherapy in patients with locally adva," Health Economics, John Wiley & Sons, Ltd., vol. 11(3), pages 233-248, April.
    9. Miguel A. Negrín & Francisco J. Vázquez‐Polo, 2006. "Bayesian cost‐effectiveness analysis with two measures of effectiveness: the cost‐effectiveness acceptability plane," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 363-372, April.
    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. 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.
    12. 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.
    13. 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.
    14. 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.
    15. F. J. Vázquez‐Polo & M. A. Negrín Hernández & B. González López‐Valcárcel, 2005. "Using covariates to reduce uncertainty in the economic evaluation of clinical trial data," Health Economics, John Wiley & Sons, Ltd., vol. 14(6), pages 545-557, June.
    16. 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.

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