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Medical Decision Making, Vol. 22, No. 4,
290-308 (2002)
DOI: 10.1177/027298902400448867
Probabilistic Analysis of Cost-Effectiveness Models: Choosing between Treatment Strategies for Gastroesophageal Reflux Disease
Andrew H. Briggs
Oxford University
Ron Goeree
McMaster University
Gord Blackhouse
McMaster University
Bernie J. O'Brien
McMaster University
When choosing between mutually exclusive treatment options,it is common to construct a cost-effectiveness frontieron the cost-effectiveness plane that represents efficientpoints from among the treatment choices. Treatment optionsinternal to the frontier are considered inefficient and are excludedeither by strict dominance or by appealing to the principleof extended dominance. However, when uncertainty isconsidered, options excluded under the baseline analysismay form part of the cost-effectiveness frontier. By adopting aBayesian approach, where distributions for model parametersare specified, uncertainty in the decision concerningwhich treatment option should be implemented is addresseddirectly. The approach is illustrated using an example from arecently published cost-effectiveness analysis of differentpossible treatment strategies for gastroesophageal reflux disease.It is argued that probabilistic analyses should be encouragedbecause they have potential to quantify the strengthof evidence in favor of particular treatment choices.
Key Words: economic evaluation • probabilistic sensitivity analysis • Bayesian methods • uncertainty • simulation
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