This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Stinnett, A. A. Articles by Mullahy, J. Search for Related Content PubMed PubMed Citation Articles by Stinnett, A. A. Articles by Mullahy, J. Pubmed/NCBI databases Medline Plus Health Information Choosing a Doctor or Health Care Service Social Bookmarking                         What's this?

Net Health Benefits

A New Framework for the Analysis of Uncertainty in Cost-Effectiveness Analysis

John Mullahy

In recent years, considerable attention has been devoted to the development of sta tistical methods for the analysis of uncertainty in cost-effectiveness (CE) analysis, with a focus on situations in which the analyst has patient-level data on the costs and health effects of alternative interventions. To date, discussions have focused almost exclu sively on addressing the practical challenges involved in estimating confidence inter vals for CE ratios. However, the general approach of using confidence intervals to convey information about uncertainty around CE ratio estimates suffers from theoretical limitations that render it inappropriate in many situations. The authors present an al ternative framework for analyzing uncertainty in the economic evaluation of health interventions (the "net health benefits" approach) that is more broadly applicable and that avoids some problems of prior methods. This approach offers several practical and theoretical advantages over the analysis of CE ratios, is straightforward to apply, and highlights some important principles in the theoretical underpinnings of CE anal ysis. Key words: cost-effectiveness; net health benefits; uncertainty. (Med Decis Mak ing 1998;18 suppl:S68-S80)

Medical Decision Making, Vol. 18, No. 2, S68-S80 (1998)
DOI: 10.1177/0272989X9801800209


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				G. E. Simon, E. J. Ludman, and C. M. Rutter Incremental Benefit and Cost of Telephone Care Management and Telephone Psychotherapy for Depression in Primary Care Arch Gen Psychiatry, October 1, 2009; 66(10): 1081 - 1089. [Abstract] [Full Text] [PDF]

				J. Sany, J.-D. Cohen, C. Combescure, M.-C. Bozonnat, F. Roch-Bras, G. Lafon, and J.-P. Daures Medico-economic evaluation of infliximab in rheumatoid arthritis--prospective French study of a cohort of 635 patients monitored for two years Rheumatology, October 1, 2009; 48(10): 1236 - 1241. [Abstract] [Full Text] [PDF]

				F. J. F. van der Sluis, J. L. Bosch, T. Terkivatan, R. A. de Man, J. N. M. IJzermans, and M. G. M. Hunink Hepatocellular Adenoma: Cost-effectiveness of Different Treatment Strategies Radiology, September 1, 2009; 252(3): 737 - 746. [Abstract] [Full Text] [PDF]

				T. Hoomans, J. L. Severens, S. M. A. A. Evers, and A. J. H. A. Ament Value for Money in Changing Clinical Practice: Should Decisions about Guidelines and Implementation Strategies Be Made Sequentially or Simultaneously? Med Decis Making, March 1, 2009; 29(2): 207 - 216. [Abstract] [PDF]

				G. Richardson, K. Bloor, J. Williams, I. Russell, D. Durai, W. Y. Cheung, A. Farrin, and S. Coulton Cost effectiveness of nurse delivered endoscopy: findings from randomised multi-institution nurse endoscopy trial (MINuET) BMJ, February 10, 2009; 338(feb10_1): b270 - b270. [Abstract] [Full Text] [PDF]

				S. Griffin, K. Claxton, and M. Sculpher Decision analysis for resource allocation in health care J Health Serv Res Policy, October 1, 2008; 13(suppl_3): 23 - 30. [Abstract] [Full Text] [PDF]

				A. J. Sutton, N. J. Cooper, S. Goodacre, and M. Stevenson Integration of Meta-analysis and Economic Decision Modeling for Evaluating Diagnostic Tests Med Decis Making, September 1, 2008; 28(5): 650 - 667. [Abstract] [PDF]

				E. Sharifi, H. Sharifi, S. Morshed, K. Bozic, and M. Diab Cost-Effectiveness Analysis of Periacetabular Osteotomy J. Bone Joint Surg. Am., July 1, 2008; 90(7): 1447 - 1456. [Abstract] [Full Text] [PDF]

				E. Castelnuovo, P. Cross, S. Mt-Isa, A. Spencer, M. Underwood, and on behalf of the TOIB study team Cost-effectiveness of advising the use of topical or oral ibuprofen for knee pain; the TOIB study [ISRCTN: 79353052] Rheumatology, July 1, 2008; 47(7): 1077 - 1081. [Abstract] [Full Text] [PDF]

				Z. Philips, K. Claxton, and S. Palmer The Half-Life of Truth: What Are Appropriate Time Horizons for Research Decisions? Med Decis Making, June 1, 2008; 28(3): 287 - 299. [Abstract] [PDF]

				J. W. Timbie, J. P. Newhouse, M. B. Rosenthal, and S.-L. T. Normand A Cost-Effectiveness Framework for Profiling the Value of Hospital Care Med Decis Making, June 1, 2008; 28(3): 419 - 434. [Abstract] [PDF]

				G Richardson, A Kennedy, D Reeves, P Bower, V Lee, E Middleton, C Gardner, C Gately, and A Rogers Cost effectiveness of the Expert Patients Programme (EPP) for patients with chronic conditions J Epidemiol Community Health, April 1, 2008; 62(4): 361 - 367. [Abstract] [Full Text] [PDF]

				S. Eckermann, A. Briggs, and A. R. Willan Health Technology Assessment in the Cost-Disutility Plane Med Decis Making, March 1, 2008; 28(2): 172 - 181. [Abstract] [PDF]

				B. Groot Koerkamp, J. J. Nikken, E. H. Oei, T. Stijnen, A. Z. Ginai, and M. G. M. Hunink Value of Information Analysis Used to Determine the Necessity of Additional Research: MR Imaging in Acute Knee Trauma as an Example Radiology, February 1, 2008; 246(2): 420 - 425. [Abstract] [Full Text] [PDF]

				E. Fenwick, K. Claxton, and M. Sculpher The Value of Implementation and the Value of Information: Combined and Uneven Development Med Decis Making, January 1, 2008; 28(1): 21 - 32. [Abstract] [PDF]

				R. A. Rosenheck, D. L. Leslie, J. L. Sindelar, E. A. Miller, P. N. Tariot, K. S. Dagerman, S. M. Davis, B. D. Lebowitz, P. Rabins, J. K. Hsiao, et al. Cost-Benefit Analysis of Second-Generation Antipsychotics and Placebo in a Randomized Trial of the Treatment of Psychosis and Aggression in Alzheimer Disease Arch Gen Psychiatry, November 1, 2007; 64(11): 1259 - 1268. [Abstract] [Full Text] [PDF]

				A. J. H. A. Ament, M. W. A. Hubben, P. E. Verweij, R. de Groot, A. Warris, J. P. Donnelly, J. v. t Wout, and J. L. Severens Economic evaluation of targeted treatments of invasive aspergillosis in adult haematopoietic stem cell transplant recipients in the Netherlands: a modelling approach J. Antimicrob. Chemother., August 1, 2007; 60(2): 385 - 393. [Abstract] [Full Text] [PDF]

				K. Noyes, A. W. Dick, and R. G. Holloway The Implications of Using US-Specific EQ-5D Preference Weights for Cost-Effectiveness Evaluation Med Decis Making, May 1, 2007; 27(3): 327 - 334. [Abstract] [PDF]

				K. D. Frick, E. W. Gower, J. H. Kempen, and J. L. Wolff Economic Impact of Visual Impairment and Blindness in the United States Arch Ophthalmol, April 1, 2007; 125(4): 544 - 550. [Abstract] [Full Text] [PDF]

				B. Groot Koerkamp, M.G. M. Hunink, T. Stijnen, J. K. Hammitt, K. M. Kuntz, and M. C. Weinstein Limitations of Acceptability Curves for Presenting Uncertainty in Cost-Effectiveness Analysis Med Decis Making, March 1, 2007; 27(2): 101 - 111. [Abstract] [PDF]

				D. Schon, S. W. Blume, K. Niebauer, C. S. Hollenbeak, and G. de Lissovoy Increasing the Use of Arteriovenous Fistula in Hemodialysis: Economic Benefits and Economic Barriers Clin. J. Am. Soc. Nephrol., March 1, 2007; 2(2): 268 - 276. [Abstract] [Full Text] [PDF]

				G. E. Simon, W. J. Katon, E. H. B. Lin, C. Rutter, W. G. Manning, M. Von Korff, P. Ciechanowski, E. J. Ludman, and B. A. Young Cost-effectiveness of Systematic Depression Treatment Among People With Diabetes Mellitus Arch Gen Psychiatry, January 1, 2007; 64(1): 65 - 72. [Abstract] [Full Text] [PDF]

				P A A Struijs, I B C Korthals-de Bos, M W van Tulder, C N van Dijk, L M Bouter, W J J Assendelft, and B M Pluim Cost effectiveness of brace, physiotherapy, or both for treatment of tennis elbow * Commentary Br. J. Sports Med., July 1, 2006; 40(7): 637 - 643. [Abstract] [Full Text] [PDF]

				W. Katon, J. Unutzer, M.-Y. Fan, J. W. Williams Jr, M. Schoenbaum, E. H.B. Lin, and E. M. Hunkeler Cost-Effectiveness and Net Benefit of Enhanced Treatment of Depression for Older Adults With Diabetes and Depression Diabetes Care, February 1, 2006; 29(2): 265 - 270. [Abstract] [Full Text] [PDF]

				M. H. Heijenbrok-Kal, E. Buskens, P. J. Nederkoorn, Y. van der Graaf, and M. G. M. Hunink Optimal Peak Systolic Velocity Threshold at Duplex US for Determining the Need for Carotid Endarterectomy: A Decision Analytic Approach Radiology, December 21, 2005; (2005) 2381041078. [Abstract] [Full Text]

				F. L. Lynch, M. Hornbrook, G. N. Clarke, N. Perrin, M. R. Polen, E. O'Connor, and J. Dickerson Cost-effectiveness of an Intervention to Prevent Depression in At-Risk Teens Arch Gen Psychiatry, November 1, 2005; 62(11): 1241 - 1248. [Abstract] [Full Text] [PDF]

				L. Ginnelly, M. Sculpher, C. Bojke, I. Roberts, A. Wade, and C. Diguiseppi Determining the cost effectiveness of a smoke alarm give-away program using data from a randomized controlled trial Eur J Public Health, October 1, 2005; 15(5): 448 - 453. [Abstract] [Full Text] [PDF]

				D. Aujesky, K. J. Smith, J. Cornuz, and M. S. Roberts Cost-Effectiveness of Low-Molecular-Weight Heparin for Treatment of Pulmonary Embolism Chest, September 1, 2005; 128(3): 1601 - 1610. [Abstract] [Full Text] [PDF]

				S. G. Thompson and R. M. Nixon How Sensitive Are Cost-Effectiveness Analyses to Choice of Parametric Distributions? Med Decis Making, July 1, 2005; 25(4): 416 - 423. [Abstract] [PDF]

				Y.-C. T. Shih, S. Han, and S. B. Cantor Impact of Generic Drug Entry on Cost-Effectiveness Analysis Med Decis Making, January 1, 2005; 25(1): 71 - 80. [Abstract] [PDF]

				A. C. Gelijns, L. D. Brown, C. Magnell, E. Ronchi, and A. J. Moskowitz Evidence, Politics, And Technological Change Health Aff., January 1, 2005; 24(1): 29 - 40. [Abstract] [Full Text] [PDF]

				A. P. Johnson-Masotti, P. W. Laud, R. G. Hoffmann, M. J. Hayat, and S. D. Pinkerton A Bayesian Approach to Net Health Benefits: An Illustration and Application to Modeling HIV Prevention Med Decis Making, November 1, 2004; 24(6): 634 - 653. [Abstract] [PDF]

				K. Noyes, A. W. Dick, R. G. Holloway, and Parkinson Study Group Pramipexole v. Levodopa as Initial Treatment for Parkinson's Disease: A Randomized Clinical-Economic Trial Med Decis Making, October 1, 2004; 24(5): 472 - 485. [Abstract] [PDF]

				J. Cook, M. Drummond, and J. F Heyse Economic endpoints in clinical trials Statistical Methods in Medical Research, April 1, 2004; 13(2): 157 - 176. [Abstract] [PDF]

				D. Wonderling, A. J Vickers, R. Grieve, and R. McCarney Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care BMJ, March 27, 2004; 328(7442): 747. [Abstract] [Full Text] [PDF]

				A. E. Ades, G. Lu, and K. Claxton Expected Value of Sample Information Calculations in Medical Decision Modeling Med Decis Making, March 1, 2004; 24(2): 207 - 227. [Abstract] [PDF]

				G. DUNN, M. MIRANDOLA, F. AMADDEO, and M. TANSELLA Describing, explaining or predicting mental health care costs: a guide to regression models: Methodological review The British Journal of Psychiatry, November 1, 2003; 183(5): 398 - 404. [Abstract] [Full Text] [PDF]

				R. Rosenheck, W. Kasprow, L. Frisman, and W. Liu-Mares Cost-effectiveness of Supported Housing for Homeless Persons With Mental Illness Arch Gen Psychiatry, September 1, 2003; 60(9): 940 - 951. [Abstract] [Full Text] [PDF]

				Y. S. Liem, M. C. J. M. Kock, J. N. M. Ijzermans, W. Weimar, K. Visser, and M.G. M. Hunink Living Renal Donors: Optimizing the Imaging Strategy--Decision- and Cost-effectiveness Analysis Radiology, January 1, 2003; 226(1): 53 - 62. [Abstract] [Full Text] [PDF]

				A O'Hagan and J W Stevens Bayesian methods for design and analysis of cost-effectiveness trials in the evaluation of health care technologies Statistical Methods in Medical Research, December 1, 2002; 11(6): 469 - 490. [Abstract] [PDF]

				G Parmigiani Measuring uncertainty in complex decision analysis models Statistical Methods in Medical Research, December 1, 2002; 11(6): 513 - 537. [Abstract] [PDF]

				A R Willan, D Y Lin, R J Cook, and E B Chen Using inverse-weighting in cost-effectiveness analysis with censored data Statistical Methods in Medical Research, December 1, 2002; 11(6): 539 - 551. [Abstract] [PDF]

				A. E. Ades and S. Cliffe Markov Chain Monte Carlo Estimation of a Multiparameter Decision Model: Consistency of Evidence and the Accurate Assessment of Uncertainty Med Decis Making, August 1, 2002; 22(4): 359 - 371. [Abstract] [PDF]

				A. P. Johnson-Masotti, P. W. Laud, R. G. Hoffmann, M. J. Hayat, and S. D. Pinkerton Probabilistic Cost-Effectiveness Analysis of HIV Prevention: Comparing a Bayesian Approach With Traditional Deterministic Sensitivity Analysis Eval Rev, August 1, 2001; 25(4): 474 - 502. [Abstract] [PDF]

				M. G. M. Hunink In Search of Tools to Aid Logical Thinking and Communicating about Medical Decision Making Med Decis Making, August 1, 2001; 21(4): 267 - 277. [Abstract] [PDF]

				A. O'Hagan and J. W. Stevens Bayesian Assessment of Sample Size for Clinical Trials of Cost-Effectiveness Med Decis Making, May 1, 2001; 21(3): 219 - 230. [Abstract] [PDF]

				G. S. R. Muradin and M. G. Myriam Hunink Cost and Patency Rate Targets for the Development of Endovascular Devices to Treat Femoropopliteal Arterial Disease Radiology, February 1, 2001; 218(2): 464 - 469. [Abstract] [Full Text]

				E. F. Halpern, M. C. Weinstein, M. G.M. Hunink, and G. S. Gazelle Representing Both First- and Second-order Uncertainties by Monte Carlo Simulation for Groups of Patients Med Decis Making, July 1, 2000; 20(3): 314 - 322. [Abstract] [PDF]

				B. A. Craig, M. A. Black, and P. P. Sendi Uncertainty in Decision Models Analyzing Cost-Effectiveness Med Decis Making, January 1, 2000; 20(1): 135 - 136. [PDF]

				M. G.M. Hunink, A. A. Stinnett, T. Stijnen, and M. C. Weinstein Letter Med Decis Making, January 1, 2000; 20(1): 136 - 137. [PDF]

				A E Ades, M J Sculpher, D M Gibb, R Gupta, and J Ratcliffe Cost effectiveness analysis of antenatal HIV screening in United Kingdom BMJ, November 6, 1999; 319(7219): 1230 - 1234. [Abstract] [Full Text]

				M. G.M. Hunink, K. M. Kuntz, K. E. Fleischmann, and T. J. Brady Noninvasive Imaging for the Diagnosis of Coronary Artery Disease: Focusing the Development of New Diagnostic Technology Ann Intern Med, November 2, 1999; 131(9): 673 - 680. [Abstract] [Full Text] [PDF]

				E. M. Laska, M. Meisner, and C. Siegel Power and Sample Size in Cost- Effectiveness Analysis Med Decis Making, August 1, 1999; 19(3): 339 - 343. [Abstract] [PDF]

				D. F. Heitjan, A. J. Moskowitz, and W. Whang Problems with Interval Estimates of the Incremental Cost--Effectiveness Ratio Med Decis Making, January 1, 1999; 19(1): 9 - 15. [Abstract] [PDF]

				A. A. Stinnett Is It Really So Bad to be Unambiguously Ineificient?: The Role of Dominance in Stochastic Cost--Effectiveness Analysis Med Decis Making, January 1, 1999; 19(1): 102 - 103. [PDF]