The Probabilistic Efficiency Frontier: A Framework for Cost-Effectiveness Analysis in Germany Put into Practice for...

Area of Science:

• Health Economics
• Health Technology Assessment
• Decision Analysis

Background:

• The German Institute for Quality and Efficiency in Health Care adapted the efficiency frontier (EF) approach for statutory cost-effectiveness analyses.
• EF is a key framework for evaluating cost-effectiveness, influencing pricing and reimbursement decisions for health technologies.

Purpose of the Study:

• To calculate an EF using multidimensional benefit, incorporating patient preferences and uncertainty.
• To assess the utility of EF in informing decision-makers about the cost-effectiveness of new therapies.
• To determine treatment efficiency at given prices using a chronic hepatitis C case study.

Main Methods:

• A single multidimensional benefit score was derived from patient-identified and weighted end points via discrete-choice experiment (DCE).
• Monte Carlo simulation was employed to aggregate overall benefit using patient preferences and clinical data.
• Uncertainty was managed using price acceptability curves (PAC) and net monetary benefit (NMB).

Main Results:

• The efficiency frontier effectively depicted the benefit and efficiency of hepatitis C virus treatments.
• Interferon-free treatments demonstrated a positive net monetary benefit (NMB) and efficiency at current prices, based on cost, effect, and preference data.

Conclusions:

• The study successfully implemented the efficiency frontier (EF) approach, integrating uncertainty and patient preferences via discrete-choice experiments (DCE).
• The combined use of DCE, EF, PAC, and NMB provides valuable insights for reimbursement and pricing decisions.