Probabilistic analysis of cost-effectiveness models: choosing between treatment strategies for gastroesophageal reflux disease

• Published in: Medical decision making Vol. 22; no. 4; pp. 290 - 308
• Main Authors: Briggs, Andrew H, Goeree, Ron, Blackhouse, Gord, O'Brien, Bernie J
• Format: Journal Article
• Language: English
• Published: United States SAGE PUBLICATIONS, INC 01-07-2002
• Subjects: Bayes Theorem; Clinical Trials as Topic; Cost-Benefit Analysis; Decision Making; Decision Support Systems, Clinical; Gastroesophageal Reflux - economics; Gastroesophageal Reflux - therapy; Histamine H2 Antagonists - economics; Histamine H2 Antagonists - therapeutic use; Humans; Life Style; Models, Statistical; Monte Carlo Method; Primary Health Care - methods; Proton Pumps - economics; Proton Pumps - therapeutic use; Treatment Outcome
• ISSN: 0272-989X; 1552-681X
• DOI: 10.1177/027298902400448867

When choosing between mutually exclusive treatment options, it is common to construct a cost-effectiveness frontier on the cost-effectiveness plane that represents efficient points from among the treatment choices. Treatment options internal to the frontier are considered inefficient and are excluded either by strict dominance or by appealing to the principle of extended dominance. However, when uncertainty is considered, options excluded under the baseline analysis may form part of the cost-effectiveness frontier. By adopting a Bayesian approach, where distributions for model parameters are specified, uncertainty in the decision concerning which treatment option should be implemented is addressed directly. The approach is illustrated using an example from a recently published cost-effectiveness analysis of different possible treatment strategies for gastroesophageal reflux disease. It is argued that probabilistic analyses should be encouraged because they have potential to quantify the strength of evidence in favor of particular treatment choices.