Cost-effective acceptability curves and a reluctance to lose
Cost-effective acceptability curves and a reluctance to lose
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DOI：
10.2165/00019053-200523120-00005
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发表时间：
2005-01-01
影响因子：
4.4
通讯作者：
Joore, MA
中科院分区：
文献类型：
--
作者：
Severens, JL;Brunenberg, DEM;Joore, MA
成本-效果可接受曲线（CEACs）是一种用于表示增量成本-效果比（ICERs）不确定性的方法。曲线的构造依赖于健康收益的支付意愿（WTP）与健康损失的接受意愿（WTA）相同的假设。本文的目的是探讨WTP和WTA之间的健康变化差异对CEACs的影响。以往的实证研究表明，WTP与WTA之间的关系并非1:1。运行状况更改的WTP和WTA之间的差异可以表示为比率：接受/拒绝比率（可以在1到无穷大之间变化）。根据这个比率，在成本效益平面的西南象限内，任何自举成本效益对将被认为具有成本效益的区域将更小，从而导致更低的CEAC。我们使用两个临床试验的数据来说明放宽1:1的WTP/WTA假设对CEACs有影响。考虑到评估每次评估的接受/拒绝比率的困难，我们建议为接受/拒绝比率的一系列值提供一系列ceac，包括1和无穷大。虽然不可能在额外福利主义框架内解释这一现象，但经验表明，个人对取消有效疗法的评价高于引入更昂贵、更有效的新疗法。在成本效益分析中，ICER的不确定性覆盖了成本效益平面的西南象限，应通过绘制多个ceac来表示社会WTP和WTA之间的差异。
Cost-effectiveness acceptability curves (CEACs) are a method used to present uncertainty surrounding incremental cost-effectiveness ratios (ICERs). Construction of the curves relies on the assumption that the willingness to pay (WTP) for health gain is identical to the willingness to accept (WTA) health loss. The objective of this paper is to explore the impact that differences between WTP and WTA health changes have on CEACs.Previous empirical evidence has shown that the relationship between WTP and WTA is not 1 : 1. The discrepancy between WTP and WTA for health changes can be expressed as a ratio: the accept/reject ratio (which can vary between 1 and infinity). Depending on this ratio, the area within the southwest quadrant of the cost-effectiveness plane in which any bootstrap cost-effect pairs will be considered to be cost effective will be smaller, resulting in a lower CEAC. We used data from two clinical trials to illustrate that relaxing the 1 : 1 WTP/WTA assumption has an impact on the CEACs. Given the difficulty in assessing the accept/reject ratio for every evaluation, we suggest presenting a series of CEACs for a range of values for the accept/reject ratio, including 1 and infinite.Although it is not possible to explain this phenomenon within the extra-welfarist framework, it has been shown empirically that individuals give a higher valuation to the removal of effective therapies than to the introduction of new therapies that are more costly and effective. In cost-effectiveness analyses where uncertainty of the ICER covers the southwest quadrant of the cost-effectiveness plane, the discrepancy between societies' WTP and WTA should be indicated by drawing multiple CEACs.