A Basic Approach to Select the Appropriate Method in case of Extended Dominance

Year 2019, , 285 - 294, 28.06.2019

Mehmet Ali Sungur , Emine Arzu Kanık Alper Ata

https://doi.org/10.18521/ktd.484905

Abstract

Objective: In cost-effectiveness analysis, treatment methods are ranked by cost and effectiveness, and a method more costly but less effective, is dominated. In models that none of the methods is absolutely dominated but one of them is extendedly dominated, selecting cost-effective method is complicated. Aim of this study was to propose a classification for magnitude of incremental cost-effectiveness ratio of extendedly dominated method, which can use for deciding about cost-effectiveness of this treatment.

Methods: Simulated data based on actual data, and simulated hypothetical data in accordance with actual data were used. All possibilities were tried to consider by generating different costs, effectiveness and response rates. Proportional magnitudes of incremental cost-effectiveness ratios of treatments extendedly dominated were investigated. Descriptive statistics for each model, and weighted means by response rates were calculated and change in percentage of extended dominance were compared.

Results: Magnitude of incremental cost-effectiveness ratio of the method extendedly dominated is a quite important factor for deciding about it, when response rates of alternative methods are similar or same. Slight changes were observed as the response rates differ from each other, but there was not an extreme impact on proportions of extended dominance.

Conclusion: A very simple and practical classification which can be used to assess the proportional magnitude of the incremental cost-effectiveness ratio of extendedly dominated treatment method and be valid regardless of whether response rates of treatments in model are same or different was suggested.

Keywords

Cost-effectiveness analysis, incremental cost-effectiveness ratio, dominance, extended dominance

Genişletilmiş Baskınlık Durumunda Uygun Yöntem Seçemi için Temel Bir Yaklaşım

Abstract

Amaç: Maliyet etkililik analizinde, tedavi yöntemleri maliyet ve etkinliğe göre sıralanır ve daha maliyetli fakat daha az etkin olan yöntem baskılanır. Yöntemlerden hiçbirinin kesin olarak baskılanmadığı, ancak bunlardan birinin genişletilmiş baskınlıkta kaldığı modellerde, maliyet-etkin yöntemin seçilmesi karmaşıktır. Bu çalışmanın amacı, genişletilmiş baskınlıkta kalan yöntemin artan maliyet-etkinlik oranı büyüklüğü için, bu tedavinin maliyet etkinliğine karar vermekte kullanılabilecek bir sınıflandırma önermektir.

Gereç ve Yöntem: Gerçek verilere dayanan simüle edilmiş veriler ve gerçek verilerle uyumlu varsayımsal veriler kullanılmıştır. Farklı maliyet, etkinlik ve yanıt oranları oluşturularak tüm olasılıklar değerlendirilmeye çalışılmıştır. Genişletilmiş baskınlıkta olan tedavilerin artan maliyet etkinlik oranlarının oransal büyüklükleri incelenmiştir. Her bir model için tanımlayıcı istatistikler ve yanıt oranlarına göre ağırlıklı ortalamalar hesaplanmış ve genişletilmiş baskınlık yüzdesindeki değişim karşılaştırılmıştır.

Bulgular: Genişletilmiş baskınlıkta kalan yöntemin artan maliyet-etkinlik oranının büyüklüğü, alternatif yöntemlerin yanıt oranları benzer veya aynı olduğunda karar vermek için oldukça önemli bir faktördür. Yanıt oranları birbirinden farklılaştıkça küçük değişiklikler gözlemlenmiş, ancak genişletilmiş baskınlık oranlarında aşırı bir etkilenme görülmemiştir.

Sonuç: Genişletilmiş baskınlıkta kalan tedavi yönteminin artan maliyet-etkinlik oranının oransal büyüklüğünü değerlendirmek ve modeldeki tedavilerin yanıt oranlarının aynı ya da farklı olduğuna bakmaksızın kullanılabilecek çok basit ve pratik bir sınıflandırma önerilmiştir.

Keywords

Maliyet-etkinlik analizi, artan maliyet-etkinlik oranı, baskınlık, genişletilmiş baskınlık

References

• 1. Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for economic evaluation of health care programmes, 3rd ed. New York: Oxford University Press, 2005.2. Muennig P. Cost-effectiveness analysis in health: A practical approach, 2nd ed. United States of America: Jossey-Bass, 2008.3. Levin HM, McEwan PJ. Cost-effectiveness analysis: Methods and applications, 2nd ed. United States of America: Sage Publications, 2001.4. Musgrove P, Fox-Rushby J. Cost-effectiveness analysis for priority setting. In: Jamison DT, Breman JG, Measham AR, et al eds. Disease control priorities in developing countries, 2nd ed. New York: Oxford University Press, 2006; 271-86.5. Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996.6. Health care cost, quality, and outcomes: ISPOR book of terms. In: Berger ML, Bingefors K, Hedblom EC, Pashos CL, Torrance GW, eds. Lawrenceville, NJ: ISPOR, 2003.7. Cost-effectiveness analysis. In: Jamison DT, Breman JG, Measham AR, et al eds. Priorities in health. New York: Oxford University Press, 2006; 39-58.8. Weinstein MC, Stason WB. Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med. 1977;296(13):716-21.9. Walker D. Cost and cost-effectiveness guidelines: Which ones to use? Health Policy Plan. 2001;16(1):113-21.10. Gafni A. Economic evaluation of health-care programmes: Is CEA better than CBA? Environ Resour Econ. 2006;34(3):407-18.11. Russell LB, Gold MR, Siegel JE, Daniels N, Weinstein MC. The role of cost-effectiveness analysis in health and medicine. JAMA. 1996;276(14):1172-7.12. Garber AM. Advances in cost-effectiveness analysis of health interventions. In: Culyer AJ, Newhouse JP, eds. Handbook of Health Economics, 1st ed. North Holland: Elsevier, 2000; 181-221.13. Owens DK. Interpretation of cost-effectiveness analyses. J Gen Intern Med. 1998;13(10):716-7.14. Ahuja J, Gupta M, Gupta AK, Kohli K. Pharmacoeconomics. Natl Med J India. 2004;17(2):80-3.15. Drummond M, Brown R, Fendrick AM, et al. Use of pharmacoeconomics information-report of the ISPOR task force on use of pharmacoeconomic/health economic information in health-care decision making. Value Health. 2003;6(4):407-16.16. Laxminarayan R, Chow J, Shahid-Salles SA. Intervention cost-effectiveness: Overview of main messages. In: Jamison DT, Breman JG, Measham AR, et al eds. Disease control priorities in developing countries, 2nd ed. New York: Oxford University Press, 2006; 35-86.17. Lothgren M, Zethraeus N, Definition, interpretation and calculation of cost-effectiveness acceptability curves. Health Econ. 2000;9(7):623-30.18. O’Hagan A, Stevens JW, Montmartin J. Inference for the cost-effectiveness acceptability curve and cost-effectiveness ratio. Pharmacoeconomics. 2000;17(4):339-49.19. Van Hout BA, Al MJ, Gordon GS, Rutten FFH. Costs, effects and C/E-ratios alongside a clinical trial. Health Econ. 1994;3(5):309-19.20. Fenwick E, Marshall DA, Levy AR, Nichol G. Using and interpreting cost-effectiveness acceptability curves: An example using data from a trial of management strategies for atrial fibrillation. BMC Health Serv Res. 2006;6:52.21. Fenwick E, Byford S. A guide to cost-effectiveness acceptability curves. Br J Psychiatry. 2005;187(2):106-8.22. Black WC. The CE plane: A graphic representation of cost-effectiveness. Med Decis Making. 1990;10(3): 212-4.23. Barton GR, Briggs AH, Fenwick EAL. Optimal cost-effectiveness decisions: The role of the cost-effectiveness acceptability curve (CEAC), the cost-effectiveness acceptability frontier (CEAF), and the expected value of perfection information (EVPI). Value Health. 2008;11(5):886-97.24. TreeAge Pro 2012 User’s Manual: TreeAge Pro 2012, © 2012 TreeAge Software Inc.25. Postma MJ, De Vries R, Welte R, Edmunds WJ. Health economic methodology illustrated with recent work on chlamydia screening: The concept of extended dominance. Sex Transm Infect. 2008;84(2):152-4.26. Ata A, Sungur MA, Kanık A, Arıcan A. Economic evaluation of sorafenib use in hepatocellular carcinoma in Turkey. 19th National Cancer Congress Abstracts. Antalya, April 20-24, 2011:467.27. MedCalc ® Version 12.2.1.0. © 1993-2012, MedCalc Software bvba. MedCalc Software, Broekstraat 52, 9030 Mariakerke, Belgium.28. TreeAge Pro 2012, Version 2012. Build-Id: 12.1.3.0-v20120504. © 1988-2012 TreeAge Software Inc.