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This version was published on April 1, 2008
Medical Decision Making, Vol. 28, No. 2, 172-181 (2008)
DOI: 10.1177/0272989X07312474

Health Technology Assessment in the Cost-Disutility Plane

Simon Eckermann, PhD

Flinders Centre for Clinical Change and Health Care Research, Flinders University, Adelaide, Australia, simon.eckermann{at}flinders.edu.au

Andrew Briggs, DPhil

Andrew R. Willan, PhD

SickKids Research Institute and University of Toronto, Ontario, Canada

Previously, comparisons of multiple strategies in health technology assessment have been undertaken on the incremental cost-effectiveness plane using efficiency frontiers and cost-effectiveness acceptability curves. This article proposes shifting the comparison of multiple strategies to the cost-disutility plane. Evidence-based decision making requires comparison of all strategies against each other. Consequently, the origin in the incremental cost-effectiveness plane cannot be the appropriate reference point in comparing multiple nondominated strategies. A linear transformation onto the cost-disutility plane allows an equivalent comparison of net benefit and permits the use of standard efficiency measurement methods to estimate 1) the degree of dominance (technical inefficiency) of dominated strategies and 2) the net benefit inefficiency (i.e., losses in net benefit relative to an optimal strategy). In comparing strategies under uncertainty, a comparison of loss in net benefit leads to the expected net loss frontier, which, unlike cost effectiveness acceptability curves, directly identifies differences in expected net benefit (net loss) and the expected value of perfect information. Thus, decision makers can be better informed about the choice of optimal strategy and the potential value of future research to resolve uncertainty. Comparing strategies in the cost-disutility plane is suggested to better inform decision making and to provide a link between the cost-effectiveness literature and efficiency measurement methods.

Key Words: health technology assessment • efficiency frontiers • maximizing net benefit • cost-disutility plane • net loss acceptability frontier • health economics • methodology • cost-effectiveness analysis. (Med Decis Making 2008;28: 172—181)


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