Probabilistic One-Way Sensitivity Analysis with Multiple Comparators: The Conditional Net Benefit Frontier
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PRACTICAL APPLICATION
Probabilistic One‑Way Sensitivity Analysis with Multiple Comparators: The Conditional Net Benefit Frontier Christopher McCabe1,2 · Giovanni Tramonti3 · Andrew Sutton1 · Peter Hall3 · Mike Paulden4 Accepted: 10 November 2020 © The Author(s) 2020
Abstract Although there have been substantial developments in the analysis of uncertainty in economic evaluations of health care programmes, the development of methods for one-way sensitivity analysis has been notably slower. Conditional incremental net benefit was recently proposed as an approach for implementing probabilistic one-way sensitivity analysis for economic evaluations comparing two strategies. In this paper, we generalise this approach to economic evaluations that compare three or more strategies. We find that ‘conditional net benefit’ may be used to conduct probabilistic one-way sensitivity analysis for economic evaluations comparing any number of strategies. We also propose the ‘conditional net benefit frontier’, which may be used to identify the most cost-effective of any number of strategies conditional upon the specific value of a parameter of interest.
Key Points
1 Introduction
Probabilistic one-way sensitivity analysis for evaluations with three or more strategies should be reported using conditional net benefit.
The use of economic evaluation to inform decisions about which strategies should be reimbursed, and for which patient groups, is accepted as standard practice in developed health care systems [1]. Decision makers are often interested in whether changes in specific parameters in the evidence base could change the assessment of whether the strategy being considered represents good or poor value for money. McCabe et al. [2] describe how the conventional approach to addressing this question, deterministic one-way sensitivity analysis, provides decision makers with biased results and hence harms the quality of decision making. They go on to describe the ‘conditional incremental net benefit’ (cINB) approach for one-way sensitivity analysis; this approach respects non-linearities in cost-effectiveness models and correlations between model parameters in order to provide less biased results. However, this ‘incremental’ approach is limited to analyses that compare only two strategies. Reimbursement decisions often consider three or more strategies, which limits the utility of the cINB approach in practice. McCabe and colleagues indicated that the underlying concepts could be generalised to analyses with more than two strategies, in a manner analogous to Barton and colleagues’ cost-effectiveness acceptability frontier (CEAF) [3]. In this short paper, we describe the specifics of this approach—the ‘conditional net benefit frontier’ (cNBF)—and illustrate this using a previously published economic evaluation [4].
The results of the probabilistic one-way sensitivity analysis for each strategy can be reported using conditional net benefit curves. The implications of the probabilistic one-way sensitivity analysis for the decision c
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