Inference for the Cost-Effectiveness Acceptability Curve and Cost-Effectiveness Ratio
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Pharmacoeconomics 2000 Apr; 17 (4): 339-349 1170-7690/00/0004-0339/$20.00/0 © Adis International Limited. All rights reserved.
Inference for the Cost-Effectiveness Acceptability Curve and Cost-Effectiveness Ratio Anthony O’Hagan,1 John W. Stevens2 and Jacques Montmartin2 1 Statistical Services Unit, University of Sheffield, Sheffield, South Yorkshire, England 2 Astra Charnwood, Loughborough, Leicestershire, England
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Inference About the Cost-Effectiveness Acceptability Curve 1.1 The Cost-Effectiveness Ratio and Acceptability . . . . . 1.2 The Cost-Effectiveness Acceptability Curve . . . . . . . 1.3 A Simpler Computation Method . . . . . . . . . . . . . . 1.4 A Frequentist Interpretation . . . . . . . . . . . . . . . . . 1.5 Example: the Anakinra Study . . . . . . . . . . . . . . . . 2. Inference About the Cost-Effectiveness Ratio . . . . . . . . . 2.1 Frequentist Inference About ρ . . . . . . . . . . . . . . . 2.2 A Bayesian Solution . . . . . . . . . . . . . . . . . . . . . . 2.3 The Anakinra Example . . . . . . . . . . . . . . . . . . . . 2.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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The aim of this article is to consider Bayesian and frequentist inference methods for measures of incremental cost effectiveness in data obtained via a clinical trial. The most useful measure is the cost-effectiveness (C/E) acceptability curve. Recent publications on Bayesian estimation have assumed a normal posterior distribution, which ignores uncertainty in estimated variances, and suggest unnecessarily complicated methods of computation. We present a simple Bayesian computation for the C/E acceptability curve and a simple frequentist analogue. Our approach takes account of errors in estimated variances, resulting in calculations that are based on distributions rather than normal distributions. If inference is required about the C/E ratio, we argue that the standard frequentist procedures give unreliable or misleading inferences, and present instead a Bayesian interval.
The increasing burden on the budgets of healthcare providers has led to a need to demonstrate that new healthcare practices provide value for money. Statistical methods for comparing the cost effec-
tiveness of a new drug or clinical procedure versus a comparative treatm
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