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A Note on Confidence Intervals in Cost-Effectiveness Analysis

Published online by Cambridge University Press:  10 March 2009

Magnus Tambour
Affiliation:
Stockholm School of Economics
Niklas Zethraeus
Affiliation:
Stockholm School of Economics
Magnus Johannesson
Affiliation:
Stockholm School of Economics

Abstract

How to obtain confidence intervals for cost-effectiveness ratios is complicated by the statistical problems of obtaining a confidence interval for a ratio of random variables. Different approaches have been suggested in the literature, but no consensus has been reached. We propose an alternative simple solution to this problem. By multiplying the effectiveness units by the price per effectiveness unit, both costs and benefits can be expressed in monetary terms and standard statistical techniques can be used to estimate a confidence interval for net benefits. This approach avoids the ratio estimation problem and explicitly recognizes that the price per effectiveness unit has to be known to provide cost-effectiveness analysis with a useful decision rule.

Type
General Essays
Copyright
Copyright © Cambridge University Press 1998

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References

REFERENCES

1.Chaudhary, M. A., & Stearns, S. C.Estimating confidence intervals for cost-effectiveness ratios: An example from a randomized trial. Statistics in Medicine, 1996, 15, 1447–58.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
2.Drummond, M., & O'Brien, B.Clinical importance, statistical significance and the assessment of economic and quality-of-life outcomes. Health Economics, 1993, 2, 205–12.CrossRefGoogle ScholarPubMed
3.Efron, B., & Tibshirani, R. J.An introduction to the bootstrap. Monographs on Statistic and Applied Probability, No. 57. New York: Chapman and Hall, 1993.CrossRefGoogle Scholar
4.Johannesson, M.Theory and methods of economic evaluation in health care. Boston: Kluwer Academic Publishers, 1996.CrossRefGoogle Scholar
5.Newbold, P.Statistics for business and economics, 3rd ed.Englewood Cliffs, NJ: Prentice-Hall, 1991.Google Scholar
6.Obenchain, R. L., Melfi, C. A., Croghan, T. W., & Buesching, D. P.Bootstrap analyses of cost-effectiveness in antidepressant pharmacotherapy. Pharmaco Economics, 1997, 11, 464–72.CrossRefGoogle ScholarPubMed
7.O'Brien, B. J., Drummond, M. F., Labelle, R. J., & Willan, A.In search of power and significance: Issues in the design and analysis of stochastic cost-effectiveness studies in health care. Medical Care, 1994, 32, 150–63.CrossRefGoogle ScholarPubMed
8.Phelps, C. E., & Mushlin, A. I.On the (near) equivalence of cost-effectiveness and cost-benefit analyses. International Journal of Technology Assessment in Health Care, 1991, 7, 1221.CrossRefGoogle ScholarPubMed
9.Wakker, P., & Klaassen, M. P.Confidence intervals for cost/effectiveness ratios. Health Economics, 1995, 4, 373–81.CrossRefGoogle ScholarPubMed
10.Weinstein, M., & Zeckhauser, R.Critical ratios and efficient allocation. Journal of Public Economics, 1973, 2, 147–57.CrossRefGoogle Scholar
11.Welch, B. L.The significance of the difference between two means when the population variances are unequal. Biometrika, 1938, 29, 350.CrossRefGoogle Scholar