Bootstrap confidence intervals for cost-effectiveness ratios: some simulation results

Recently, a number of papers have brought up the issue of how to make cost-effectiveness (CE) studies stochastic, i.e. how to obtain confidence intervals for CE ratios. In this note we present a bootstrap procedure for estimating bias-corrected confidence intervals for CE ratios. The bootstrap procedure is tested in a simulation study based on the assumptions made in a recent paper by Wakker and Klaassen in this journal. We test two variants of CE ratio bootstrap confidence intervals. The first is a bootstrap analogue of the parametric method proposed by Wakker and Klaassen which gives results similar to those obtained with the parametric method. However, computing bootstrap confidence intervals directly for the CE ratio produce results closer to the predetermined significance level.