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Cost-effectiveness acceptability curves--caveats quantified.

Michał Jakubczyk1, Bogumił Kamiński

  • 1Division of Decision Analysis and Support, Warsaw School of Economics, Warsaw, Poland. michal.jakubczyk@gmail.com

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Summary

Cost-effectiveness acceptability curves (CEACs) can lead to inconsistent health technology assessment decisions. This study reveals when CEACs diverge from expected net benefit maximization, impacting policy choices.

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Area of Science:

  • Health Economics
  • Health Technology Assessment
  • Decision Analysis

Background:

  • Cost-effectiveness acceptability curves (CEACs) are prevalent in health technology assessment.
  • Concerns exist regarding the reliability of CEACs as a decision-making tool.

Purpose of the Study:

  • To elucidate the discrepancies between using CEACs and maximizing expected net benefit (NB).
  • To identify conditions under which CEACs yield inconsistent decisions in health technology assessment.
  • To analyze the influence of statistical properties on CEAC shapes and decision consistency.

Main Methods:

  • Comparative analysis of CEACs versus expected net benefit maximization.
  • Investigation of decision inconsistencies in pairwise and joint comparisons.
  • Examination of factors influencing CEAC shape, including skewness, correlation, and variance.

Main Results:

  • CEACs can lead to different conclusions than expected NB maximization, particularly with two alternatives.
  • The discrepancy is linked to the expected value of perfect information.
  • CEAC shape is sensitive to the skewness, variance, and correlation of cost-effectiveness estimates.
  • With multiple alternatives, CEACs can result in non-transitive choices and violate the independence of irrelevant alternatives property.

Conclusions:

  • CEACs may not always align with optimal decision-making based on expected net benefit.
  • Understanding the limitations and influencing factors of CEACs is crucial for reliable health technology assessment.
  • Careful consideration of CEAC properties is needed to avoid inconsistent policy recommendations.