Beyond the cost‐effectiveness acceptability curve: The appropriateness of rank probabilities for presenting the results of economic evaluation in multiple technology appraisal

Epstein, David

doi:10.1002/hec.3884

Cited by 7 publications

(6 citation statements)

References 13 publications

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“…Capturing uncertainty for multiple variables involves assessing standard deviation and confidence intervals; however, this is complicated when dealing with a ratio (incremental cost effectiveness ratio—ICER). A common approach to capturing uncertainty for ratio variables is a probability sensitivity analysis using Monte Carlo simulation, as this can lead to a cost-effectiveness acceptability curve (CEAC) [ 35 ]. In this study, 1000 different values for all cost and QALY values are generated, and this leads to a CEAC curve that plots the probability of cost effectiveness against different threshold values, as shown in Figure 1 below.…”

Section: Resultsmentioning

confidence: 99%

An Economic Evaluation of ‘Sheds for Life’: A Community-Based Men’s Health Initiative for Men’s Sheds in Ireland

McGrath

Murphy

Egan

et al. 2022

IJERPH

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Men’s Sheds (‘Sheds’) attract a diverse cohort of men and, as such, have been identified as spaces with the potential to engage marginalized subpopulations with more structured health promotion. ‘Sheds for Life’ is a 10-week men’s health initiative for Sheds in Ireland and the first structured health promotion initiative formally evaluated in Sheds. Cost is an important implementation outcome in the evaluation of Sheds for Life when operating in an environment where budgets are limited. Therefore, an economic evaluation is critical to highlight cost-effectiveness for decision makers who determine sustainability. This is the first study to evaluate the cost-effectiveness of health endeavors in Sheds. All costs from pre-implementation to maintenance phases were gathered, and questionnaires incorporating the SF-6D were administered to participants (n = 421) at baseline, 3, 6, and 12 months. Then, utility scores were generated to determine quality-adjusted life years (QALYS). Results demonstrate that the intervention group experienced an average 3.3% gain in QALYS from baseline to 3 months and a further 2% gain from 3 months to 6 months at an estimated cost per QALY of €15,724. These findings highlight that Sheds for Life is a cost-effective initiative that effectively engages and enhances the well-being of Shed members.

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Section: Resultsmentioning

confidence: 99%

An Economic Evaluation of ‘Sheds for Life’: A Community-Based Men’s Health Initiative for Men’s Sheds in Ireland

McGrath

Murphy

Egan

et al. 2022

IJERPH

View full text Add to dashboard Cite

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“…The methods are (A) net benefit density plot, 18 (B) stochastic dominance plot, 16 (C) incremental benefit density plot, 18 (D) incremental benefit curve, 19 (E) return-risk space, 20 and (F) cumulative rankogram. 21 To produce these plots, the willingness-to-pay threshold was fixed at 50,000 €/quality-adjusted life-year for all figures. The probability density plots are normalized smoothened histograms of the net monetary benefits, using 100 and 500 bins for A and C, and the smoothening parameter was set at 0.5 (see Appendix 1C,D for the smoothening algorithm).…”

Section: Resultsmentioning

confidence: 99%

“…In situations in which a fixed WTP is acceptable, the return-risk space 20 and the cumulative rankogram 21 provide less information than the net benefit density plot 18 and stochastic dominance 16 as they use point estimates and ranks instead of distributions. The incremental benefit curve 19 performs better on graphical discriminatory ability and interpretability than do the net benefit density plot, 18 the incremental benefit density plot, 19 and stochastic dominance.…”

Section: Discussionmentioning

confidence: 99%

Methods for Communicating the Impact of Parameter Uncertainty in a Multiple-Strategies Cost-Effectiveness Comparison

et al. 2022

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Purpose Analyzing and communicating uncertainty is essential in medical decision making. To judge whether risks are acceptable, policy makers require information on the expected outcomes but also on the uncertainty and potential losses related to the chosen strategy. We aimed to compare methods used to represent the impact of uncertainty in decision problems involving many strategies, enhance existing methods, and provide an open-source and easy-to-use tool. Methods We conducted a systematic literature search to identify methods used to represent the impact of uncertainty in cost-effectiveness analyses comparing multiple strategies. We applied the identified methods to probabilistic sensitivity analysis outputs of 3 published decision-analytic models comparing multiple strategies. Subsequently, we compared the following characteristics: type of information conveyed, use of a fixed or flexible willingness-to-pay threshold, output interpretability, and the graphical discriminatory ability. We further proposed adjustments and integration of methods to overcome identified limitations of existing methods. Results The literature search resulted in the selection of 9 methods. The 3 methods with the most favorable characteristics to compare many strategies were 1) the cost-effectiveness acceptability curve (CEAC) and cost-effectiveness acceptability frontier (CEAF), 2) the expected loss curve (ELC), and 3) the incremental benefit curve (IBC). The information required to assess confidence in a decision often includes the average loss and the probability of cost-effectiveness associated with each strategy. Therefore, we proposed the integration of information presented in an ELC and CEAC into a single heat map. Conclusions This article presents an overview of methods presenting uncertainty in multiple-strategy cost-effectiveness analyses, with their strengths and shortcomings. We proposed a heat map as an alternative method that integrates all relevant information required for health policy and medical decision making. Highlights To assess confidence in a chosen course of action, decision makers require information on both the probability and the consequences of making a wrong decision. This article contains an overview of methods for presenting uncertainty in multiple-strategy cost-effectiveness analyses. We propose a heat map that combines the probability of cost-effectiveness from the cost-effectiveness acceptability curve (CEAC) with the consequences of a wrong decision from the expected loss curve. Collapsing of the CEAC can be reduced by relaxing the CEAC, as proposed in this article. Code in Microsoft Excel and R is provided to easily analyze data using the methods discussed in this article.

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“…Rank-o-grams show the distribution of the probabilities that each intervention is most cost-effective, second most cost-effective, third most cost-effective, and so on for each of the 14 interventions, at a fixed willingness to pay threshold, in this case £20 000 per QALY. 53 The x-axis reports each of the possible ranks, for which position 1 means that the intervention is most cost-effective. The y-axis shows the probability that each intervention has been ranked at each of the possible positions and therefore fully encapsulates the uncertainty in the intervention rankings.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness Analysis of Smoking Cessation Interventions in the United Kingdom Accounting for Major Neuropsychiatric Adverse Events

et al. 2021

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Smoking is a leading cause of death worldwide. Cessation aids include varenicline, bupropion, nicotine replacement therapy (NRT), and e-cigarettes at various doses (low, standard and high) and used alone or in combination with each other. Previous cost-effectiveness analyses have not fully accounted for adverse effects nor compared all cessation aids. The objective was to determine the relative cost-effectiveness of cessation aids in the United Kingdom. Methods: An established Markov cohort model was adapted to incorporate health outcomes and costs due to depression and self-harm associated with cessation aids, alongside other health events. Relative efficacy in terms of abstinence and major adverse neuropsychiatric events was informed by a systematic review and network meta-analysis. Base case results are reported for UK-licensed interventions only. Two sensitivity analyses are reported, one including unlicensed interventions and another comparing all cessation aids but removing the impact of depression and self-harm. The sensitivity of conclusions to model inputs was assessed by calculating the expected value of partial perfect information. Results: When limited to UK-licensed interventions, varenicline standard-dose and NRT standard-dose were most costeffective. Including unlicensed interventions, e-cigarette low-dose appeared most cost-effective followed by varenicline standard-dose 1 bupropion standard-dose combined. When the impact of depression and self-harm was excluded, varenicline standard-dose 1 NRT standard-dose was most cost-effective, followed by varenicline low-dose 1 NRT standard-dose. Conclusion: Although found to be most cost-effective, combined therapy is currently unlicensed in the United Kingdom and the safety of e-cigarettes remains uncertain. The value-of-information analysis suggested researchers should continue to investigate the long-term effectiveness and safety outcomes of e-cigarettes in studies with active comparators.

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Beyond the cost‐effectiveness acceptability curve: The appropriateness of rank probabilities for presenting the results of economic evaluation in multiple technology appraisal

Cited by 7 publications

References 13 publications

An Economic Evaluation of ‘Sheds for Life’: A Community-Based Men’s Health Initiative for Men’s Sheds in Ireland

An Economic Evaluation of ‘Sheds for Life’: A Community-Based Men’s Health Initiative for Men’s Sheds in Ireland

Methods for Communicating the Impact of Parameter Uncertainty in a Multiple-Strategies Cost-Effectiveness Comparison

Cost-Effectiveness Analysis of Smoking Cessation Interventions in the United Kingdom Accounting for Major Neuropsychiatric Adverse Events

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