OP34 One-Way Sensitivity Analysis For Cost Effectiveness Analysis

2019 ◽  
Vol 35 (S1) ◽  
pp. 8-8
Author(s):  
Christopher McCabe ◽  
Isaac Awotwe ◽  
Mike Paulden ◽  
Andrew Sutton ◽  
Peter Hall
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Stochastic Analysis ◽  
Cost Effectiveness Analysis ◽  
Decision Makers ◽  
Net Benefit ◽  
Effectiveness Analysis ◽  
Incremental Net Benefit ◽  
Parameter Values ◽  
The Impact

IntroductionAlthough stochastic analysis has become the accepted standard for decision analytic cost effectiveness models, deterministic one-way sensitivity analysis continues to be used to meet the needs of decision makers to understand the impact that changing the value taken by one specific parameter has on the results of the analysis. However, there are a number of problems with this approach.MethodsWe review the reasons why deterministic one-way sensitivity analysis will provide decision makers with biased and incomplete information. We then describe a new method - stochastic one-way sensitivity analysis (SOWSA), and apply this to a previously published cost effectiveness analysis, to produce a stochastic tornado diagram and conditional incremental net benefit curve. We then discuss how these outputs should be interpreted and the potential barriers to the implementation of SOWSA.ResultsThe results illustrate the shortcomings of the current approaches to deterministic one-way sensitivity analysis. For SOWSA, the expected costs and outcomes are captured, along with the sampled value of the parameter and these are linked to the probability that the parameter takes that value – which can be read off the probability distribution for the parameter used in the stochastic analysis. From these results it is possible to gain insights into probability that a parameter will take a value that will change a decision.ConclusionsAlthough a well-used technique, one-way deterministic sensitivity analysis has a number of shortcomings that may contribute to incorrect conclusions being drawn about the importance of certain parameter values on model results. By providing fuller information on uncertainty in model results, it is hoped that the methods here will lead to more informed decision making. Although, as with all developments in the presentation of analytic results to decision makers, care will be required to ensure that the decision makers understand the information provided to them.

scholarly journals Impact of Socioeconomic Differences on Distributional Cost-effectiveness Analysis

2020 ◽  
Vol 40 (5) ◽  
pp. 606-618
Author(s):  
Fan Yang ◽  
Colin Angus ◽  
Ana Duarte ◽  
Duncan Gillespie ◽  
Simon Walker ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Inequality ◽  
Local Level ◽  
National Level ◽  
Cost Effectiveness Analysis ◽  
Decision Makers ◽  
Socioeconomic Differences ◽  
Screening And Brief Intervention ◽  
Effectiveness Analysis ◽  
The Impact

Public health decision makers value interventions for their effects on overall health and health inequality. Distributional cost-effectiveness analysis (DCEA) incorporates health inequality concerns into economic evaluation by accounting for how parameters, such as effectiveness, differ across population groups. A good understanding of how and when accounting for socioeconomic differences between groups affects the assessment of intervention impacts on overall health and health inequality could inform decision makers where DCEA would add most value. We interrogated 2 DCEA models of smoking and alcohol policies using first national level and then local authority level information on various socioeconomic differences in health and intervention use. Through a series of scenario analyses, we explored the impact of altering these differences on the DCEA results. When all available evidence on socioeconomic differences was incorporated, provision of a smoking cessation service was estimated to increase overall health and increase health inequality, while the screening and brief intervention for alcohol misuse was estimated to increase overall health and reduce inequality. Ignoring all or some socioeconomic differences resulted in minimal change to the estimated impact on overall health in both models; however, there were larger effects on the estimated impact on health inequality. Across the models, there were no clear patterns in how the extent and direction of socioeconomic differences in the inputs translated into the estimated impact on health inequality. Modifying use or coverage of either intervention so that each population group matched the highest level improved the impacts to a greater degree than modifying intervention effectiveness. When local level socioeconomic differences were considered, the magnitude of the impacts was altered; in some cases, the direction of impact on inequality was also altered.

scholarly journals The Impact of Outliers on Net-Benefit Regression Model in Cost-Effectiveness Analysis

PLoS ONE ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. e65930 ◽  
Author(s):  
Yu-Wen Wen ◽  
Yi-Wen Tsai ◽  
David Bin-Chia Wu ◽  
Pei-Fen Chen
Keyword(s):  
Cost Effectiveness ◽  
Regression Model ◽  
Cost Effectiveness Analysis ◽  
Net Benefit ◽  
Effectiveness Analysis ◽  
The Impact

Cost Effectiveness Analysis of Antipsychotic Medications in the Management of Schizophrenia in Benin City

2019 ◽  
Vol 1 (1) ◽  
pp. 46-56
Author(s):  
J.W. Edefo ◽  
◽  
S.F. Usifoh ◽  
A.W. Udezi ◽  
◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Rating Scale ◽  
Response Rate ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Antipsychotic Medications ◽  
Stable Relationship ◽  
Effectiveness Analysis ◽  
The Impact

Background: Studies on cost effectiveness analysis (CEA) of typical versus atypical antipsychotics in the management of schizophrenia are still lacking in Nigeria thus the objectives of this study are to determine which of the class of antipsychotics is more cost-effective as well as the impact of socio-demographic factors on the response rate to antipsychotics. Method: The effectiveness was measured by Brief Psychiatric rating scale (BPRS) and costs were in Nigerian naira (NGN). The impact of different socio-demographics on the mean BPRScore ± Standard deviation (SD) reduction was determined. The study was conducted from patient’s perspective with decision tree analysis model using two-way sensitivity analysis. The model was used to explore incremental cost effectiveness ratios (ICER) of oral antipsychotic medications Haloperidol /Trifluoperazine versus Olanzepine /Risperidone over a 24-week study period. Results: Cost effectiveness analysis with 1st scenario sensitivity test of medications, trifluoperazine 17.81±2.51mg is more cost effective than olanzapine 10mg, while haloperidol 10mg is more cost effective than risperidone 3.5± 0.51mg. In the second scenario of sensitivity analysis, olanzapine is more cost effective than trifluoperazine only when the savings of making one person free from schizophrenia in a month is worth more than NGN537 while risperidone is more cost effective than haloperidol only when the savings of making one person free from schizophrenia in a month is worth more than NGN2524.1. The effect on response rate to antipsychotics gave p=0.0251, P=0.009, P<0.0001 for educational status, income, stable relationship respectively. Conclusion: Atypical antipsychotic medications are not more cost effective compared to the typical antipsychotics. Higher educational level, income and stable relationship positively affected the outcome of effectiveness of antipsychotics.

Complementing the net benefit approach: A new framework for Bayesian cost-effectiveness analysis

2009 ◽  
Vol 25 (4) ◽  
pp. 537-545 ◽  
Author(s):  
Miguel Angel Negrín Hernández ◽  
Francisco José Vázquez-Polo ◽  
Francisco Javier Girón González-Torre ◽  
Elías Moreno Bas
Keyword(s):  
Cost Effectiveness ◽  
Real Data ◽  
Cost Effectiveness Analysis ◽  
Net Benefit ◽  
Underlying Distribution ◽  
Effectiveness Analysis ◽  
Incremental Net Benefit ◽  
The Mean ◽  
High Degree ◽  
New Framework

Objectives: The aim of cost-effectiveness analysis is to maximize health benefits from a given budget, taking a societal perspective. Consequently, the comparison of alternative treatments or technologies is solely based on their expected effectiveness and cost. However, the expectation, or mean, poses important limitations as it might be a poor summary of the underlying distribution, for instance when the effectiveness is a categorical variable, or when the distributions of either effectiveness or cost present a high degree of asymmetry. Clinical variables often present these characteristics.Methods: In this study, we present a framework for cost-effectiveness analysis based on the whole posterior distribution of effectiveness and cost.Results: An application with real data is included to illustrate the analysis. Decision-making measures such as the incremental cost-effectiveness ratio, incremental net-benefit, and cost-effectiveness acceptability curves, can also be defined under the new framework.Conclusions: This framework overcomes limitations of the mean and offers complementary information for the decision maker.

scholarly journals Global stability and cost-effectiveness analysis of COVID-19 considering the impact of the environment: using data from Ghana

2020 ◽  
Vol 140 ◽  
pp. 110103 ◽  
Author(s):  
Joshua Kiddy K. Asamoah ◽  
Mark A. Owusu ◽  
Zhen Jin ◽  
F. T. Oduro ◽  
Afeez Abidemi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Global Stability ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Using Data ◽  
The Impact

scholarly journals A Systematic Review of WTA-WTP Disparity for Dental Interventions and Implications for Cost-Effectiveness Analysis

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 301
Author(s):  
Pedram Sendi ◽  
Arta Ramadani ◽  
Nicola U. Zitzmann ◽  
Michael M. Bornstein
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Health Gain ◽  
Analytical Framework ◽  
Health Condition ◽  
Cost Effectiveness Analysis ◽  
Cochrane Library ◽  
Effectiveness Analysis ◽  
Substantial Risk ◽  
The Impact

Cost-effectiveness analysis is widely adopted as an analytical framework to evaluate whether health care interventions represent value for money, and its use in dentistry is increasing. Traditionally, in cost-effectiveness analysis, one assumes that the decision maker’s maximum willingness to pay (WTP) for health gain is equivalent to his minimum willingness to accept (WTA) monetary compensation for health loss. It has been documented in the literature that losses are weighted higher than equivalent gains, i.e., that WTA exceeds WTP for the same health condition, resulting in a WTA/WTP ratio greater than 1. There is a knowledge gap of published WTA/WTP ratios for dental interventions in the literature. We therefore conducted a (i) systematic review of published WTA-WTP estimates in dentistry (MEDLINE, Web of Science, Cochrane Library, London, UK) and (ii) a patient-level analysis of WTA/WTP ratios of included studies, and (iii) we demonstrate the impact of a WTA-WTP disparity on cost-effectiveness analysis. Out of 55 eligible studies, two studies were included in our review. The WTA/WTP ratio ranged from 2.58 for discontinuing water fluoridation to 5.12 for mandibular implant overdentures, indicating a higher disparity for implant rehabilitations than for dental public health interventions. A WTA-WTP disparity inflates the cost-effectiveness of dental interventions when there is a substantial risk of both lower costs and health outcomes. We therefore recommend that in these cases the results of cost-effectiveness analyses are reported using different WTA/WTP ratios in a sensitivity analysis.

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