Pulling cost-effectiveness analysis up by its bootstraps: A non-parametric approach to confidence interval estimation
Pulling cost-effectiveness analysis up by its bootstraps: A non-parametric approach to confidence interval estimation
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DOI：
10.1002/(sici)1099-1050(199707)6:4
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发表时间：
1997-07-01
期刊：
影响因子：
2.1
通讯作者：
Mooney, CZ
中科院分区：
文献类型：
--
作者：
Briggs, AH;Wonderling, DE;Mooney, CZ
在卫生保健干预措施的经济评估中，最重要的统计数据是增量成本效益比（ICER），它被定义为两种治疗干预措施之间的成本差异超过其效果差异。如果有关于成本和健康结果的患者特定数据，自然会尝试使用置信区间来量化估计的ICER的不确定性。最近的文章集中讨论了构造置信区间的参数方法。本文描述了非参数自举置信区间的构造。这种间隔的优点是它们不依赖于ICER抽样分布的参数假设。我们提出了应用于临床试验数据的非参数自举的详细描述，以展示该方法的优点和缺点。随着自举重复次数的增加，我们对自举置信限进行了连续检验，得出结论：百分比自举置信区间方法为估计ICER点估计的不确定性提供了一种很有前途的方法。然而，对偏差和标准误差的连续自举估计表明，这些可能是不稳定的；因此，我们强烈建议对这种估计作出谨慎的解释。(C) 1997年，John Wiley & Sons, Ltd。
The statistic of interest in the economic evaluation of health care interventions is the incremental cost effectiveness ratio (ICER), which is defined as the difference in cost between two treatment interventions over the difference in their effect. Where patient-specific data on costs and health outcomes are available, it is natural to attempt to quantify uncertainty in the estimated ICER using confidence intervals. Recent articles have focused on parametric methods for constructing confidence intervals. In this paper, we describe the construction of non-parametric bootstrap confidence intervals. The advantage of such intervals is that they do not depend on parametric assumptions of the sampling distribution of the ICER. We present a detailed description of the non-parametric bootstrap applied to data from a clinical trial, in order to demonstrate the strengths and weaknesses of the approach. By examining the bootstrap confidence limits successively as the number of bootstrap replications increases, we conclude that percentile bootstrap confidence interval methods provide a promising approach to estimating the uncertainty of ICER point estimates. However, successive bootstrap estimates of bias and standard error suggests that these may be unstable; accordingly, we strongly recommend a cautious interpretation of such estimates. (C) 1997 by John Wiley & Sons, Ltd.