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Incremental cost-effectiveness analysis: the optimal strategy depends on the strategy set
1University of Texas M.D. Anderson Cancer Center, Department of Medical Specialties, Houston 77030-4095, USA.
Journal of Clinical Epidemiology
|July 17, 1999
Summary
The choice of comparison strategies significantly impacts cost-effectiveness analysis results. Carefully selecting alternatives is crucial for accurate healthcare technology assessments and policy decisions.
Area of Science:
- Health economics
- Medical decision making
- Clinical strategy evaluation
Background:
- Incremental cost-effectiveness analysis (ICER) is vital for technology adoption decisions.
- The selection of comparator strategies can influence ICER outcomes.
- Previous studies provide a foundation for cost and effectiveness assumptions.
Purpose of the Study:
- To demonstrate how the choice of alternatives affects cost-effectiveness analysis.
- To analyze the incremental cost-effectiveness of estriol screening for Down syndrome.
Main Methods:
- Utilized a cost-effectiveness model based on published data.
- Compared four clinical strategies, including a 'do nothing' approach.
- Evaluated incremental cost-effectiveness ratios (ICERs) under different strategy sets.
Main Results:
- Including a 'do nothing' strategy led to extended dominance, rendering two strategies non-cost-effective.
- Excluding the 'do nothing' strategy allowed all remaining three strategies to be potentially cost-effective.
- The starting point for analysis critically influences the interpretation of cost-effectiveness.
Conclusions:
- The incremental cost-effectiveness of clinical strategies is highly sensitive to the comparator set.
- Policy decisions based on ICERs require careful consideration of the analytical framework.
- Methodological choices in cost-effectiveness analysis have significant implications for healthcare policy.
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