Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion.
Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion.
复制标题
DOI：
10.3390/healthcare9111419
复制
发表时间：
2021-10-22
期刊：
影响因子：
--
通讯作者：
Schwenkglenks M
中科院分区：
文献类型：
--
作者：
Sendi P;Matter-Walstra K;Schwenkglenks M
在经济评价中处理不确定性的方法受到了文献的广泛关注，成本-效果可接受度曲线（CEAC）是在成本-效果分析中最广泛使用的方法，用于总结和呈现与项目成本和效果相关的不确定性。一些研究人员强调了CEAC在为决策者提供信息方面的局限性，因为CEAC对成本效益平面（CEP）的东北和西南象限的增量成本和效应联合分布的径向变化不敏感。此外，有人指出，CEAC在评估不确定的成本和影响时没有纳入风险规避。在本文中，我们证明了成本-效益-负担能力曲线（CEAFC）捕获了增量成本和对CEP影响的联合分布的两个维度，因此对CEP联合分布的径向变化很敏感。此外，CEAFC还可以告知新干预措施的预算影响，因为它可以用来估计干预措施既负担得起又具有成本效益的联合概率。此外，我们表明，成本效益风险厌恶曲线（CERAC）允许分析师将不同程度的风险厌恶纳入分析，因此，可以用来通知风险厌恶的决策者。我们使用帕博西尼加来曲唑与来曲唑单独治疗雌激素受体阳性、HER-2阴性晚期乳腺癌的成本-效果模型的数据，以证明CEAC、CEAFC和CERAC之间的差异，并展示如何联合使用这些数据为决策者提供信息。
Methods to handle uncertainty in economic evaluation have gained much attention in the literature, and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarise and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some researchers have emphasised the limitations of the CEAC for informing decision and policy makers, as the CEAC is insensitive to radial shifts of the joint distribution of incremental costs and effects in the North-East and South-West quadrants of the cost-effective plane (CEP). Furthermore, it has been pointed out that the CEAC does not incorporate risk-aversion in valuing uncertain costs and effects. In the present article, we show that the cost-effectiveness affordability curve (CEAFC) captures both dimensions of the joint distribution of incremental costs and effects on the CEP and is, therefore, sensitive to radial shifts of the joint distribution on the CEP. Furthermore, the CEAFC also informs about the budget impact of a new intervention, as it can be used to estimate the joint probability that an intervention is both affordable and cost-effective. Moreover, we show that the cost-effectiveness risk-aversion curve (CERAC) allows the analyst to incorporate different levels of risk-aversion into the analysis and can, therefore, be used to inform decision-makers who are risk-averse. We use data from a published cost-effectiveness model of palbociclib in addition to letrozole versus letrozole alone for the treatment of oestrogen-receptor positive, HER-2 negative, advanced breast cancer to demonstrate the differences between CEAC, CEAFC and CERAC, and show how these can jointly be used to inform decision and policy makers.
登录
查看更多内容
影响因子：
3.6
作者：
Stinnett, AA;Mullahy, J
通讯作者：
Mullahy, J
DOI：
10.2471/blt.06.038893
发表时间：
2007-11-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Kim, Sun-Young;Salomon, Joshua A;Goldie, Sue J
通讯作者：
Goldie, Sue J
影响因子：
2.1
作者：
Al, MJ;Feenstra, TL;van Hout, BA
通讯作者：
van Hout, BA
影响因子：
2.1
作者：
Sendi, P;Gafni, A;Birch, S
通讯作者：
Birch, S
DOI：
10.1007/s10754-008-9032-4
发表时间：
2008-06-01
期刊：
INTERNATIONAL JOURNAL OF HEALTH CARE FINANCE & ECONOMICS
影响因子：
--
作者：
Sendi, Pedram
通讯作者：
Sendi, Pedram