Optimal cost-effectiveness decisions: The role of the cost-effectiveness acceptability curve (CEAC), the cost-effectiveness acceptability frontier (CEAF), and the expected value of perfection information (EVPI)
Optimal cost-effectiveness decisions: The role of the cost-effectiveness acceptability curve (CEAC), the cost-effectiveness acceptability frontier (CEAF), and the expected value of perfection information (EVPI)
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DOI：
10.1111/j.1524-4733.2008.00358.x
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发表时间：
2008-09-01
期刊：
影响因子：
4.5
通讯作者：
Fenwick, Elisabeth A. L.
中科院分区：
文献类型：
--
作者：
Barton, Garry R.;Briggs, Andrew H.;Fenwick, Elisabeth A. L.
目的：演示如何在评估多个备选方案的成本效益时提出最佳决策以及与该决策相关的不确定性水平。为了探索和解释潜在的违反直觉的结果，可能会出现时，分析多个选项。方法：创建一个模板，基于多变量正态性的假设，为了复制以前的分析，比较多个选项的成本效益。我们使用这个模板来解释成本-效果可接受性曲线（CEAC）、成本-效果可接受性边界（CEAF）和完美信息期望值（EVPI）可能采用的一些不同形状，以及多个选项之间的变化的相关结构和方差。我们证明了：1）一个受扩展优势支配的期权有可能在某些成本效益阈值下具有最高的成本效益概率; 2）最具成本效益（最佳）的选择永远不会具有成本效益的最高概率;以及3）当做出错误决策的概率降低时，EVPI增加。改变多个选项之间的相关性结构并没有改变的成本效益plane.Conclusion的结果的介绍：成本效益平面在代表周围的不确定性多个选项，因为它不能代表选项之间的相关性有限的使用。CEAC可以代表决策的不确定性，但不应用于确定最佳决策。相反，CEAF显示了围绕最优选择的决策不确定性，这可以通过EVPI来增强，以显示进一步研究的潜在收益。
Objective: To demonstrate how the optimal decision and level of uncertainty associated with that decision, can be presented when assessing the cost-effectiveness of multiple options. To explore and explain potentially counterintuitive results that can arise when analyzing multiple options.Methods: A template was created, based on the assumption of multivariate normality, in order to replicate a previous analysis that compared the cost-effectiveness of multiple options. We used this template to explain some of the different shapes that the cost-effectiveness acceptability curve (CEAC), cost-effectiveness acceptability frontier (CEAF), and expected value of perfection information (EVPI) may take, with changing correlation structure and variance between the multiple options.Results: We show that it is possible for 1) an option that is subject to extended dominance to have the highest probability of being cost-effective for some values of the cost-effectiveness threshold; 2) the most cost-effective (optimal) option to never have the highest probability of being cost-effective; and 3) the EVPI to increase when the probability of making the wrong decision decreases. Changing the correlation structure between multiple options did not change the presentation of results on the cost-effectiveness plane.Conclusion: The cost-effectiveness plane has limited use in representing the uncertainty surrounding multiple options as it cannot represent correlation between the options. CEACs can represent decision uncertainty, but should not be used to determine the optimal decision. Instead, the CEAF shows the decision uncertainty surrounding the optimal choice and this can be augmented by the EVPI to show the potential gains to further research.