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Medical Decision Making
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A Bayesian Approach to Net Health Benefits: An Illustration and Application to Modeling HIV Prevention

Ana P. Johnson-Masotti, PhD

Clinical Epidemiology and Biostatistics Department, McMaster University, Hamilton, Ontario, Canada and Department of Psychiatry and Behavior Medicine, Medical College of Wisconsin, Milwaukee

Purushottam W. Laud, PhD

Division of Biostatistics, Medical College of Wisconsin, Milwaukee

Raymond G. Hoffmann, PhD

Division of Biostatistics, Medical College of Wisconsin, Milwaukee

Matthew J. Hayat, PhD

Division of Biostatistics, Medical College of Wisconsin, Milwaukee and National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland

Steven D. Pinkerton, PhD

Department of Psychiatry and Behavior Medicine, Medical College of Wisconsin, Milwaukee

Purpose. To conduct a cost-effectiveness analysis of HIV prevention when costs and effects cannot be measured directly. To quantify the total estimation of uncertainty due to sampling variability as well as inexact knowledge of HIV transmission parameters. Methods. The authors focus on estimating the incremental net health benefit (INHB) in a randomized trial of HIV prevention with intervention and control conditions. Using a Bernoulli model of HIV transmission, changes in the participants’ risk behaviors are converted into the number of HIV infections averted. A sampling model is used to account for variation in the behavior measurements. Bayes’s theorem and Monte Carlo methods are used to attain the stated objectives. Results. The authors obtained a positive mean INHB of 0.0008, indicating that advocacy training is just slightly favored over the control condition for men, assuming a $50,000 per quality-adjusted life year (QALY) threshold. To be confident of a positive INHB, the decision maker would need to spend more than $100,000 per QALY.

Key Words: cost-effectiveness • Bayesian • net benefit, HIV

Medical Decision Making, Vol. 24, No. 6, 634-653 (2004)
DOI: 10.1177/0272989X04271040
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