Policymaking based on CERs: changes in costs are not the same as changes in benefits
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BioMed Central
Open Access
Methodology
Policymaking based on CERs: changes in costs are not the same as changes in benefits Andre JHA Ament* and Silvia MAA Evers Address: Department of Health Organization, Policy and Economics, University of Maastricht, Maastricht, the Netherlands Email: Andre JHA Ament* - [email protected]; Silvia MMA Evers - [email protected] * Corresponding author
Published: 23 March 2005 Cost Effectiveness and Resource Allocation 2005, 3:3
doi:10.1186/1478-7547-3-3
Received: 11 May 2004 Accepted: 23 March 2005
This article is available from: http://www.resource-allocation.com/content/3/1/3 © 2005 Ament and Evers; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Earlier cost-effectiveness studies showed the cost-effectiveness ratios for pneumococcal vaccination in preventing cases of Bacteremic Pneumococcal Disease (BPD) alone to vary between € 11,000 and € 33,000 per quality-adjusted life year. If vaccination is also assumed to be effective in preventing cases of Non Bacteremic Pneumococcal Disease (NBPD) (at the same level of effectiveness), vaccinating all elderly persons becomes highly cost-effective or even cost saving. Methods: The present article examines the effect of partial preventive power of the vaccine against cases of NBPD additional to its preventive power against cases of BPD, and the consequences this has in terms of cost-effectiveness. Results: The analysis shows that even a fairly small additional preventive power against cases of NBPD leads to a dramatic and unexpected decrease in the cost-effectiveness ratio. Conclusion: Because a Cost-Effectiveness Ratio (CER) is a ratio, changes in costs and changes in effects have rather different influences on its value. There is a linear relation between a change in costs and a change in CER if the effects are kept constant. This linear relation is not found on the effect side. Assuming that costs are constant, a change in effect will be different for low levels of effect than for high levels.
Introduction Data on efficacy or effectiveness are often among the cornerstones of the calculations of Cost-Effectiveness Ratios (CERs) and information on such effect variables is crucial for the decision-making process [1,2]. As an example, this article considers the lack of information regarding the effectiveness of the vaccine for pneumococcal pneumonia. There is rather strong evidence that this vaccine prevents cases of Bacteremic Pneumococcal Disease (BPD), which however represents only a minority
of cases of pneumococcal disease (about 15%) [3-7]. There is much less evidence (some experts say no evidence) that the vaccine also prevents cases of Non Bacteremic Pneumococcal Disease (NBPD) [8]. Several published studies have calculated cost-effectiveness
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