Output correlations in probabilistic models with multiple alternatives

Eur J Health Econ. 2015 Mar;16(2):133-9. doi: 10.1007/s10198-013-0558-0. Epub 2014 Jan 4.

Abstract

A comprehensive cost-effectiveness decision model will often go beyond a one-to-one comparison and will include a number of competing alternatives. Only a simultaneous assessment of all relevant treatment alternatives avoids comparing average cost-effectiveness ratios and allows a truly incremental analysis. Two issues arise if the analysis is probabilistic, namely, the occurrence of output correlations and difficulty in presenting the results. I have examined the role of output correlations using a screening model with eight alternatives and have shown that specifically cost-cost and quality-adjusted life years (QALY)-QALY correlations between alternatives have a major impact on decision uncertainty, as measured by the probability of the cost-effectiveness and expected value of perfect information. In particular, the latter strongly depends on between-alternative output correlations. This analysis shows that both the expected value of perfect information plots and acceptability curves/frontiers are sensitive to output correlations and thus appropriate for presentation of multiple alternatives. To avoid confusing statistical significance and economic importance I propose that acceptability curves be augmented by incremental net-benefit density plots at a given willingness to pay threshold.

MeSH terms

  • Cost-Benefit Analysis
  • Models, Econometric
  • Models, Statistical*
  • Quality-Adjusted Life Years*
  • Technology Assessment, Biomedical / methods*