Fieller's method and net health benefits

Area of Science:

• Health Economics
• Biostatistics
• Pharmacoeconomics

Background:

• The incremental cost-effectiveness ratio (ICER) presents statistical and conceptual estimation challenges in health economic evaluations.
• Net health benefit (NHB) analysis offers an alternative framework for assessing cost-effectiveness.
• NHB is calculated by comparing treatment effectiveness and costs against a threshold rate.

Purpose of the Study:

• To explore the relationship between incremental net health benefit (INHB) and the incremental cost-effectiveness ratio (ICER).
• To demonstrate how confidence intervals for INHB can be constructed at various threshold rates.
• To elucidate the implications of these findings for NHB analysis interpretation.

Main Methods:

• Reviewing the derivation of Fieller's method confidence sets for ICER.
• Defining INHB as the difference in mean effectiveness, adjusted for cost by subtracting foregone health at a marginal cost-effectiveness rate.
• Constructing confidence intervals for INHB across different threshold rates.

Main Results:

• The set of threshold rates where treatments are not significantly different in INHB analysis is equivalent to the Fieller's method confidence set for the ICER.
• This equivalence provides a statistical link between INHB and ICER confidence intervals.
• Numerical examples illustrate the application and interpretation of these confidence sets.

Conclusions:

• The study establishes a formal connection between confidence intervals for INHB and Fieller's method for ICER.
• This finding simplifies the interpretation of NHB analyses by leveraging established statistical methods for ICER.
• The results support the use of INHB as a viable and statistically sound alternative for cost-effectiveness evaluation.