Cost-effectiveness analysis under multiple effectiveness outcomes: A probabilistic approach

Document Type

Journal Article

Publication Date

7-3-2023

Journal

Statistics in medicine

DOI

10.1002/sim.9841

Keywords

U-statistics; cost-effectiveness probability (CEP); lower confidence limit; parametric bootstrap

Abstract

Probability based criteria are proposed for the assessment of cost-effectiveness of a new treatment compared to a standard treatment when there are multiple effectiveness measures. Depending on the preferences of a policy maker, there are several options to define such criteria. Two such metrics are investigated in detail. One metric is defined as the conditional probability that a new treatment is more effective with respect to the multiple effectiveness measures for patients having lower costs under the new treatment. A second metric is defined as the conditional probability that a new treatment is less costly for patients having greater health benefits under the new treatment. The metrics offer considerable flexibility to a policy maker as thresholds for cost and effectiveness can be incorporated into the metrics. Parametric confidence limits are developed using a percentile bootstrap approach assuming multivariate normality for the joint distribution of the log(cost) and effectiveness measures. A non-parametric estimation procedure is also developed using the theory of U-statistics. Numerical results indicate that the proposed confidence limits accurately maintain coverage probabilities. The methodologies are illustrated using a study on the treatment of type two diabetes. Code implementing the proposed methods are provided in the supporting information.

Department

Biostatistics and Bioinformatics

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