Fieller's method and net health benefits

Abstract

Statistical and conceptual difficulties complicate the estimation of the incremental cost‐effectiveness ratio (ICER). An alternative approach is to measure cost‐effectiveness by the incremental net health benefit (INHB), defined as the difference in mean effectiveness of a new treatment compared with a standard, adjusted for cost difference by subtracting the health foregone if purchasing care at the rate of a marginally cost‐effective therapy. Because net health benefit (NHB) is dependent on this threshold rate, one can construct confidence intervals for the INHB at various values of the rate. It turns out that the set of rates where new and standard are not significantly different is equal to the Fieller's method confidence set for the ICER. We review the derivation of the Fieller's method confidence set, present numerical examples, and discuss the implications of our result for the calculation and interpretation of NHB analyses. Copyright © 2000 John Wiley & Sons, Ltd.

Bowel Preparation for Colonoscopy: A Comparative Cost - Effective Analysis of Traditional Per OS Purgatory Prep V ersus a Novel Method Using High - Volume Colonic Water Irrigation

“…Also, unlike ICER, the NHB is a monotonic function of both health and cost. Health policymakers should favor a strategy for which the NHB takes the greatest positive value in relation to values of WTP that seem reasonable with respect to known public policy [26]. For analysis of the results of the Monte Carlo analysis, relative risk with 95% confidence intervals and number needed to treat (NNT) were calculated.…”

Bowel Preparation for Colonoscopy: A Comparative Cost - Effective Analysis of Traditional Per OS Purgatory Prep V ersus a Novel Method Using High - Volume Colonic Water Irrigation

“…Also, unlike ICER, the NHB is a monotonic function of both health and cost. Health policymakers should favor a strategy for which the NHB takes the greatest positive value in relation to values of WTP that seem reasonable with respect to known public policy [26]. For analysis of the results of the Monte Carlo analysis, relative risk with 95% confidence intervals and number needed to treat (NNT) were calculated.…”

Computing Expected Value of Partial Sample Information from Probabilistic Sensitivity Analysis Using Linear Regression Metamodeling

“…We use incremental net benefit (INB) as our measure of cost-effectiveness instead of the cost-effectiveness ratio because it has attractive statistical properties in our application. 42–44 INB measures the incremental net benefit of adopting the optimal strategy ( t * ) relative to an alternative ( t * ) based on the current evidence. An intervention’s net benefit ( B ), when expressed in a monetary value, measures the savings from an intervention ( t ) relative to a marginally cost-effective intervention at a specified willingness-to-pay threshold.…”

An economic analysis of endoscopic ablative therapy for management of nondysplastic Barrett’s esophagus

“…where E represents effectiveness, C represents cost, and WTP is the willingness to pay (i. e. the decision maker's threshold ICER) [60,61]. The NHB is the health effect of the treatment minus the benefit that one would have obtained by investing the resources spent on a marginally effective treatment.…”

Bowel Preparation for Colonoscopy: A Comparative Cost - Effective Analysis of Traditional Per OS Purgatory Prep V ersus a Novel Method Using High - Volume Colonic Water Irrigation

“…Also, unlike ICER, the NHB is a monotonic function of both health and cost. Health policymakers should favor a strategy for which the NHB takes the greatest positive value in relation to values of WTP that seem reasonable with respect to known public policy [26]. For analysis of the results of the Monte Carlo analysis, relative risk with 95% confidence intervals and number needed to treat (NNT) were calculated.…”

Computing Expected Value of Partial Sample Information from Probabilistic Sensitivity Analysis Using Linear Regression Metamodeling

“…We use incremental net benefit (INB) as our measure of cost-effectiveness instead of the cost-effectiveness ratio because it has attractive statistical properties in our application. 42–44 INB measures the incremental net benefit of adopting the optimal strategy ( t * ) relative to an alternative ( t * ) based on the current evidence. An intervention’s net benefit ( B ), when expressed in a monetary value, measures the savings from an intervention ( t ) relative to a marginally cost-effective intervention at a specified willingness-to-pay threshold.…”

An economic analysis of endoscopic ablative therapy for management of nondysplastic Barrett’s esophagus

“…where E represents effectiveness, C represents cost, and WTP is the willingness to pay (i. e. the decision maker's threshold ICER) [60,61]. The NHB is the health effect of the treatment minus the benefit that one would have obtained by investing the resources spent on a marginally effective treatment.…”

Bowel Preparation for Colonoscopy: A Comparative Cost - Effective Analysis of Traditional Per OS Purgatory Prep V ersus a Novel Method Using High - Volume Colonic Water Irrigation

“…Also, unlike ICER, the NHB is a monotonic function of both health and cost. Health policymakers should favor a strategy for which the NHB takes the greatest positive value in relation to values of WTP that seem reasonable with respect to known public policy [26]. For analysis of the results of the Monte Carlo analysis, relative risk with 95% confidence intervals and number needed to treat (NNT) were calculated.…”

Computing Expected Value of Partial Sample Information from Probabilistic Sensitivity Analysis Using Linear Regression Metamodeling

“…We use incremental net benefit (INB) as our measure of cost-effectiveness instead of the cost-effectiveness ratio because it has attractive statistical properties in our application. 42–44 INB measures the incremental net benefit of adopting the optimal strategy ( t * ) relative to an alternative ( t * ) based on the current evidence. An intervention’s net benefit ( B ), when expressed in a monetary value, measures the savings from an intervention ( t ) relative to a marginally cost-effective intervention at a specified willingness-to-pay threshold.…”

An economic analysis of endoscopic ablative therapy for management of nondysplastic Barrett’s esophagus

“…where E represents effectiveness, C represents cost, and WTP is the willingness to pay (i. e. the decision maker's threshold ICER) [60,61]. The NHB is the health effect of the treatment minus the benefit that one would have obtained by investing the resources spent on a marginally effective treatment.…”