Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion

Methods to handle uncertainty in economic evaluation have gained much attention in the literature, and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarise and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some...

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Autores principales:	Pedram Sendi, Klazien Matter-Walstra, Matthias Schwenkglenks
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	economic evaluation cost-effectiveness analysis risk-aversion budget impact uncertainty health care costs Medicine R
Acceso en línea:	https://doaj.org/article/471e61af2c5c43dcb8d62eec98c9b1e7
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spelling	oai:doaj.org-article:471e61af2c5c43dcb8d62eec98c9b1e72021-11-25T17:43:41ZHandling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion10.3390/healthcare91114192227-9032https://doaj.org/article/471e61af2c5c43dcb8d62eec98c9b1e72021-10-01T00:00:00Zhttps://www.mdpi.com/2227-9032/9/11/1419https://doaj.org/toc/2227-9032Methods to handle uncertainty in economic evaluation have gained much attention in the literature, and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarise and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some researchers have emphasised the limitations of the CEAC for informing decision and policy makers, as the CEAC is insensitive to radial shifts of the joint distribution of incremental costs and effects in the North-East and South-West quadrants of the cost-effective plane (CEP). Furthermore, it has been pointed out that the CEAC does not incorporate risk-aversion in valuing uncertain costs and effects. In the present article, we show that the cost-effectiveness affordability curve (CEAFC) captures both dimensions of the joint distribution of incremental costs and effects on the CEP and is, therefore, sensitive to radial shifts of the joint distribution on the CEP. Furthermore, the CEAFC also informs about the budget impact of a new intervention, as it can be used to estimate the joint probability that an intervention is both affordable and cost-effective. Moreover, we show that the cost-effectiveness risk-aversion curve (CERAC) allows the analyst to incorporate different levels of risk-aversion into the analysis and can, therefore, be used to inform decision-makers who are risk-averse. We use data from a published cost-effectiveness model of palbociclib in addition to letrozole versus letrozole alone for the treatment of oestrogen-receptor positive, HER-2 negative, advanced breast cancer to demonstrate the differences between CEAC, CEAFC and CERAC, and show how these can jointly be used to inform decision and policy makers.Pedram SendiKlazien Matter-WalstraMatthias SchwenkglenksMDPI AGarticleeconomic evaluationcost-effectiveness analysisrisk-aversionbudget impactuncertaintyhealth care costsMedicineRENHealthcare, Vol 9, Iss 1419, p 1419 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	economic evaluation cost-effectiveness analysis risk-aversion budget impact uncertainty health care costs Medicine R
spellingShingle	economic evaluation cost-effectiveness analysis risk-aversion budget impact uncertainty health care costs Medicine R Pedram Sendi Klazien Matter-Walstra Matthias Schwenkglenks Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion
description	Methods to handle uncertainty in economic evaluation have gained much attention in the literature, and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarise and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some researchers have emphasised the limitations of the CEAC for informing decision and policy makers, as the CEAC is insensitive to radial shifts of the joint distribution of incremental costs and effects in the North-East and South-West quadrants of the cost-effective plane (CEP). Furthermore, it has been pointed out that the CEAC does not incorporate risk-aversion in valuing uncertain costs and effects. In the present article, we show that the cost-effectiveness affordability curve (CEAFC) captures both dimensions of the joint distribution of incremental costs and effects on the CEP and is, therefore, sensitive to radial shifts of the joint distribution on the CEP. Furthermore, the CEAFC also informs about the budget impact of a new intervention, as it can be used to estimate the joint probability that an intervention is both affordable and cost-effective. Moreover, we show that the cost-effectiveness risk-aversion curve (CERAC) allows the analyst to incorporate different levels of risk-aversion into the analysis and can, therefore, be used to inform decision-makers who are risk-averse. We use data from a published cost-effectiveness model of palbociclib in addition to letrozole versus letrozole alone for the treatment of oestrogen-receptor positive, HER-2 negative, advanced breast cancer to demonstrate the differences between CEAC, CEAFC and CERAC, and show how these can jointly be used to inform decision and policy makers.
format	article
author	Pedram Sendi Klazien Matter-Walstra Matthias Schwenkglenks
author_facet	Pedram Sendi Klazien Matter-Walstra Matthias Schwenkglenks
author_sort	Pedram Sendi
title	Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion
title_short	Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion
title_full	Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion
title_fullStr	Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion
title_full_unstemmed	Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion
title_sort	handling uncertainty in cost-effectiveness analysis: budget impact and risk aversion
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/471e61af2c5c43dcb8d62eec98c9b1e7
work_keys_str_mv	AT pedramsendi handlinguncertaintyincosteffectivenessanalysisbudgetimpactandriskaversion AT klazienmatterwalstra handlinguncertaintyincosteffectivenessanalysisbudgetimpactandriskaversion AT matthiasschwenkglenks handlinguncertaintyincosteffectivenessanalysisbudgetimpactandriskaversion
_version_	1718412039569801216

Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion

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