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)
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. A template was creat...
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| Published in | Value in health Vol. 11; no. 5; pp. 886 - 897 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | English |
| Published |
Malden, USA
Elsevier Inc
01.09.2008
Blackwell Publishing Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1098-3015 1524-4733 1524-4733 |
| DOI | 10.1111/j.1524-4733.2008.00358.x |
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| Abstract | 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.
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.
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.
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. |
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| AbstractList | 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.OBJECTIVETo 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.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.METHODSA 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.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.RESULTSWe 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.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.CONCLUSIONThe 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. 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. 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. 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. 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. 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. Adapted from the source document. ABSTRACT 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. Abstract 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. |
| Author | Briggs, Andrew H. Barton, Garry R. Fenwick, Elisabeth A.L. |
| Author_xml | – sequence: 1 givenname: Garry R. surname: Barton fullname: Barton, Garry R. email: g.barton@uea.ac.uk organization: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK – sequence: 2 givenname: Andrew H. surname: Briggs fullname: Briggs, Andrew H. organization: Public Health & Health Policy, University of Glasgow, Glasgow, UK – sequence: 3 givenname: Elisabeth A.L. surname: Fenwick fullname: Fenwick, Elisabeth A.L. organization: Public Health & Health Policy, University of Glasgow, Glasgow, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/18489513$$D View this record in MEDLINE/PubMed |
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| Copyright | 2008 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2008, International Society for Pharmacoeconomics and Outcomes Research (ISPOR) |
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| Keywords | cost-effectiveness plane cost-effectiveness acceptability frontier (CEAF) expected value of perfect information (EVPI), uncertainty cost-effectiveness acceptability curve (CEAC) |
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| References | Palmer, Smith (bib280) 2000; 19 UK BEAM Trial Team (bib180) 2004; 329 Legood, Gray, Wolstenholme (bib40) 2006; 332 Ades, Sculpher, Sutton (bib250) 2006; 24 Goeree, O'Brien, Blackhouse (bib10) 2002; 5 Ramsey, Berry, Etzioni (bib30) 2003; 348 Miller, Chilvers, Dewey (bib20) 2003; 19 Elliott, Hooper, Payne (bib80) 2006; 45 Cantor (bib110) 1994; 14 Fenwick, O'Brien, Briggs (bib220) 2004; 13 Claxton, Sculpher, Drummond (bib120) 2002; 360 van Hout, Al, Gordon (bib210) 1994; 3 Kamath, Kremers, Vanness (bib70) 2003; 6 Claxton (bib230) 1999; 8 Claxton, Cohen, Neumann (bib240) 2005; 24 Chessa, Dekker, van Vliet (bib300) 1999; 19 Briggs, Goeree, Blackhouse (bib270) 2002; 22 Black (bib190) 1990; 10 Fenwick, Claxton, Sculpher (bib170) 2001; 10 Coast (bib50) 2004; 329 Weinstein (bib100) 1990; 6 Ades, Lu (bib290) 2003; 23 Briggs (bib260) 1999; 8 Sculpher, Claxton (bib130) 2005; 8 Koerkamp, Hunink, Stijnen (bib60) 2007; 27 Fenwick, Palmer, Claxton (bib140) 2006; 26 O'Hagan, McCabe, Akehurst (bib160) 2005; 23 Briggs, Sculpher, Claxton (bib200) 2006 Brown, Hooper, Elliott (bib90) 2006; 10 Claxton (bib150) 1999; 18 1990; 10 2006; 10 2002; 360 2006 2003; 19 2004; 329 1999; 8 2006; 332 2005; 23 2003; 348 2005; 24 2003; 6 2000; 19 2006; 45 2006; 24 1999; 19 1999; 18 2005; 8 2006; 26 2004; 13 2002; 22 2002; 5 1994; 14 1994; 3 1990; 6 2007; 27 2001; 10 2003; 23 Fenwick (10.1111/j.1524-4733.2008.00358.x_bib170) 2001; 10 Briggs (10.1111/j.1524-4733.2008.00358.x_bib270) 2002; 22 O'Hagan (10.1111/j.1524-4733.2008.00358.x_bib160) 2005; 23 Coast (10.1111/j.1524-4733.2008.00358.x_bib50) 2004; 329 Claxton (10.1111/j.1524-4733.2008.00358.x_bib150) 1999; 18 Legood (10.1111/j.1524-4733.2008.00358.x_bib40) 2006; 332 Elliott (10.1111/j.1524-4733.2008.00358.x_bib80) 2006; 45 Fenwick (10.1111/j.1524-4733.2008.00358.x_bib220) 2004; 13 Ramsey (10.1111/j.1524-4733.2008.00358.x_bib30) 2003; 348 Koerkamp (10.1111/j.1524-4733.2008.00358.x_bib60) 2007; 27 UK BEAM Trial Team (10.1111/j.1524-4733.2008.00358.x_bib180) 2004; 329 van Hout (10.1111/j.1524-4733.2008.00358.x_bib210) 1994; 3 Palmer (10.1111/j.1524-4733.2008.00358.x_bib280) 2000; 19 Kamath (10.1111/j.1524-4733.2008.00358.x_bib70) 2003; 6 Ades (10.1111/j.1524-4733.2008.00358.x_bib290) 2003; 23 Chessa (10.1111/j.1524-4733.2008.00358.x_bib300) 1999; 19 Weinstein (10.1111/j.1524-4733.2008.00358.x_bib100) 1990; 6 Brown (10.1111/j.1524-4733.2008.00358.x_bib90) 2006; 10 Cantor (10.1111/j.1524-4733.2008.00358.x_bib110) 1994; 14 Claxton (10.1111/j.1524-4733.2008.00358.x_bib120) 2002; 360 Ades (10.1111/j.1524-4733.2008.00358.x_bib250) 2006; 24 Fenwick (10.1111/j.1524-4733.2008.00358.x_bib140) 2006; 26 Claxton (10.1111/j.1524-4733.2008.00358.x_bib230) 1999; 8 Briggs (10.1111/j.1524-4733.2008.00358.x_bib200) 2006 Briggs (10.1111/j.1524-4733.2008.00358.x_bib260) 1999; 8 Miller (10.1111/j.1524-4733.2008.00358.x_bib20) 2003; 19 Black (10.1111/j.1524-4733.2008.00358.x_bib190) 1990; 10 Sculpher (10.1111/j.1524-4733.2008.00358.x_bib130) 2005; 8 Claxton (10.1111/j.1524-4733.2008.00358.x_bib240) 2005; 24 Goeree (10.1111/j.1524-4733.2008.00358.x_bib10) 2002; 5 |
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publication-title: Health Affairs – volume: 332 start-page: 79 year: 2006 end-page: 85 ident: bib40 article-title: Lifetime effects, costs, and cost effectiveness of testing for human papillomavirus to manage low grade cytological abnormalities: results of the NHS pilot studies publication-title: BMJ – volume: 8 start-page: 269 year: 1999 end-page: 274 ident: bib230 article-title: Bayesian approaches to the value of information: implications for the regulation of new pharmaceuticals publication-title: Health Econ – volume: 6 start-page: 93 year: 1990 end-page: 103 ident: bib100 article-title: Principles of cost-effective resource allocation in health care organizations publication-title: Int J Technol Assess Health Care – volume: 10 start-page: 1 year: 2006 end-page: 183 ident: bib90 article-title: A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug induced gastrointestinal toxicity: a systematic review with economic modelling publication-title: Health Technol Assess – volume: 27 start-page: 101 year: 2007 end-page: 111 ident: bib60 article-title: Limitations of acceptability curves for presenting uncertainty in cost-effectiveness analysis publication-title: Med Decis Making – volume: 329 start-page: 1233 year: 2004 end-page: 1236 ident: bib50 article-title: Is economic evaluation in touch with society's health values? 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| Snippet | To demonstrate how the optimal decision and level of uncertainty associated with that decision, can be presented when assessing the cost-effectiveness of... Abstract Objective To demonstrate how the optimal decision and level of uncertainty associated with that decision, can be presented when assessing the... ABSTRACT Objective: To demonstrate how the optimal decision and level of uncertainty associated with that decision, can be presented when assessing the... Objective: To demonstrate how the optimal decision and level of uncertainty associated with that decision, can be presented when assessing the... |
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| SubjectTerms | Acceptability Bayes Theorem Cost effectiveness Cost-Benefit Analysis - statistics & numerical data cost-effectiveness acceptability curve (CEAC) cost-effectiveness acceptability frontier (CEAF) cost-effectiveness plane Decision Support Techniques expected value of perfect information (EVPI) expected value of perfect information (EVPI), uncertainty Humans Internal Medicine Models, Economic Models, Statistical Models, Theoretical Multivariate Analysis Normality Perfectionism Probability Sensitivity and Specificity Thresholds Uncertainty United States |
| Title | 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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