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PharmacoEconomics
Published in: PharmacoEconomics 2/2013

01-02-2013 | Practical Application

Cost-Effectiveness Acceptability Curves Revisited

Author: Maiwenn J. Al

Published in: PharmacoEconomics | Issue 2/2013

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Abstract

Since the introduction of the cost-effectiveness acceptability curve (CEAC) in 1994, its use as a method to describe uncertainty around incremental cost-effectiveness ratios (ICERs) has steadily increased. In this paper, first the construction and interpretation of the CEAC is explained, both in the context of modelling studies and in the context of cost-effectiveness (CE) studies alongside clinical trials. Additionally, this paper reviews the advantages and limitations of the CEAC. Many of the perceived limitations can be attributed to the practice of interpreting the CEAC as a decision rule while it was not developed as such. It is argued that the CEAC is still a useful tool in describing and quantifying uncertainty around the ICER, especially in combination with other tools such as plots on the CE plane and value-of-information analysis.
Literature
1.
van Hout BA, Al MJ, Gordon GS, et al. Costs, effects and C/E-ratios alongside a clinical trial. Health Econ. 1994;3(5):309–19.PubMedCrossRef
2.
O’Brien BJ, Drummond MF, Labelle RJ, et al. In search of power and significance: issues in the design and analysis of stochastic cost-effectiveness studies in health care. Med Care. 1994;32:150–63.PubMedCrossRef
3.
Wakker P, Klaassen MP. Confidence intervals for cost/effectiveness ratios. Health Econ. 1995;4(5):373–81.PubMedCrossRef
4.
Sacristan JA, Day SJ, Navarro O, et al. Use of confidence intervals and sample size calculations in health economic studies. Ann Pharmacother. 1995;29:719–25.PubMed
5.
Fieller EC. Some problems in interval estimation. J R Stat Soc Ser B Methodol. 1954;16(2):175–85.
6.
Chaudhary MA, Stearns SC. Estimating confidence intervals for cost-effectiveness ratios: an example from a randomized trial. Stat Med. 1996;15:1447–58.PubMedCrossRef
7.
Efron B, Tibshirani RJ. An introduction to the bootstrap. New York: Chapman and Hall; 1993.
8.
Polsky D, Glick HA, Willke R, et al. Confidence intervals for cost-effectiveness ratios: a comparison of four methods. Health Econ. 1997;6:243–52.PubMedCrossRef
9.
Briggs A, Fenn P. Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane. Health Econ. 1998;7:723–40.PubMedCrossRef
10.
Meckley LM, Greenberg D, Cohen JT, et al. The adoption of cost-effectiveness acceptability curves in cost-utility analyses. Med Decis Making. 2010;30(3):314–9.PubMedCrossRef
11.
Black WC. The CE plane: a graphic representation of cost-effectiveness. Med Decis Making. 1990;10(3):212–4.PubMedCrossRef
12.
Weinstein MC, Zechhauser R. Critical ratios and efficient allocation. J Public Econ. 1973;2:147–57.CrossRef
13.
Cleemput I, Neyt M, Thiry N, et al. Using threshold values for cost per quality-adjusted life-year gained in healthcare decisions. Int J Technol Assess Health Care. 2011;27(1):71–6.PubMedCrossRef
14.
National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. London: NICE; 2008.
15.
16.
17.
Doubilet P, Begg CB, Weinstein MC, et al. Probabilistic sensitivity analysis using Monte Carlo simulation: a practical approach. Med Decis Making. 1985;5(2):157–77.PubMedCrossRef
18.
Briggs AH, Gray A. The distribution of health care costs and their statistical analysis for economic evaluation. J Health Serv Res Policy. 1998;3(4):233–45.PubMed
19.
Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Making. 1998;18(2 Suppl.):S68–80.PubMedCrossRef
20.
Fenwick E, O’Brien BJ, Briggs A. Cost-effectiveness acceptability curves: facts, fallacies and frequently asked questions. Health Econ. 2004;13(5):405–15.PubMedCrossRef
21.
Fenwick E, Claxton K, Sculpher M. Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ. 2001;10(8):779–87.PubMedCrossRef
22.
Heitjan DF, Moskowitz AJ, Whang W. Bayesian estimation of cost-effectiveness ratios from clinical trials. Health Econ. 1999;8(3):191–201.PubMedCrossRef
23.
Barton GR, Briggs AH, Fenwick EA. Optimal cost-effectiveness decisions: the role of the cost-effectiveness acceptability curve (CEAC), the cost-effectiveness acceptability frontier (CEAF), and the expected value of perfection information (EVPI). Value Health. 2008;11(5):886–97.PubMedCrossRef
24.
Löthgren M, Zethraeus N. Definition, interpretation and calculation of cost-effectiveness acceptability curves. Health Econ. 2000;9(7):623–30.PubMedCrossRef
25.
Groot Koerkamp B, Hunink MG, Stijnen T, et al. Limitations of acceptability curves for presenting uncertainty in cost-effectiveness analysis. Med Decis Making. 2007;27(2):101–11.PubMedCrossRef
26.
Fenwick E, Briggs A. Cost-effectiveness acceptability curves in the dock: case not proven? Med Decis Making. 2007;27(2):93–5.PubMedCrossRef
27.
Jakubczyk M, Kaminski B. Cost-effectiveness acceptability curves: caveats quantified. Health Econ. 2010;19(8):955–63.PubMedCrossRef
28.
Sadatsafavi M, Najafzadeh M, Marra C. Technical note: acceptability curves could be misleading when correlated strategies are compared. Med Decis Making. 2008;28(3):306–7.PubMedCrossRef
29.
Briggs AH. A Bayesian approach to stochastic cost-effectiveness analysis. Health Econ. 1999;8(3):257–61.PubMedCrossRef
30.
Claxton K. The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies. J Health Econ. 1999;18(3):341–64.PubMedCrossRef
31.
Al MJ, Feenstra TL, van Hout BA. Optimal allocation of resources over health care programmes: dealing with decreasing marginal utility and uncertainty. Health Econ. 2005;14(7):655–67.PubMedCrossRef
32.
Al MJ, Feenstra T, Brouwer WB. Decision makers’ views on health care objectives and budget constraints: results from a pilot study. Health Policy. 2004;70(1):33–48.PubMedCrossRef
33.
Arrow K, Lind A. Uncertainty and the evaluation of public investment decisions. Am Econ Rev. 1970;60:364–78.
34.
Palmer S, Smith PC. Incorporating option values into the economic evaluation of health care technologies. J Health Econ. 2000;19(5):755–66.PubMedCrossRef
35.
Griffin SC, Claxton KP, Palmer SJ, et al. Dangerous omissions: the consequences of ignoring decision uncertainty. Health Econ. 2011;20(2):212–24.PubMedCrossRef
36.
Fenwick E, Claxton K, Sculpher M. The value of implementation and the value of information: combined and uneven development. Med Decis Making. 2008;28(1):21–32.PubMedCrossRef
37.
Hoomans T, Fenwick EA, Palmer S, et al. Value of information and value of implementation: application of an analytic framework to inform resource allocation decisions in metastatic hormone-refractory prostate cancer. Value Health. 2009;12(2):315–24.PubMedCrossRef
38.
Eckermann S, Willan AR. Presenting evidence and summary measures to best inform societal decisions when comparing multiple strategies. Pharmacoeconomics. 2011;29(7):563–77.PubMed
Metadata
Title
Cost-Effectiveness Acceptability Curves Revisited
Author
Maiwenn J. Al
Publication date
01-02-2013
Publisher
Springer International Publishing AG
Published in
PharmacoEconomics / Issue 2/2013
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.1007/s40273-012-0011-8

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