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Better informing decision making with multiple outcomes cost-effectiveness analysis under uncertainty in cost-disutility space

McCaffrey, Nikki, Agar, Meera, Harlum, Janeane, Karnon, Jonathon, Currow, David and Eckermann, Simon 2015, Better informing decision making with multiple outcomes cost-effectiveness analysis under uncertainty in cost-disutility space, PLoS one, vol. 10, no. 3, pp. 1-19, doi: 10.1371/journal.pone.0115544.

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Title Better informing decision making with multiple outcomes cost-effectiveness analysis under uncertainty in cost-disutility space
Author(s) McCaffrey, NikkiORCID iD for McCaffrey, Nikki orcid.org/0000-0003-3684-3723
Agar, Meera
Harlum, Janeane
Karnon, Jonathon
Currow, David
Eckermann, Simon
Journal name PLoS one
Volume number 10
Issue number 3
Article ID e0115544
Start page 1
End page 19
Total pages 19
Publisher PLoS
Place of publication San Francisco, Calif.
Publication date 2015
ISSN 1932-6203
Keyword(s) Cost-Benefit Analysis
Decision Making
Health Care Costs
Humans
Quality-Adjusted Life Years
Summary INTRODUCTION: Comparing multiple, diverse outcomes with cost-effectiveness analysis (CEA) is important, yet challenging in areas like palliative care where domains are unamenable to integration with survival. Generic multi-attribute utility values exclude important domains and non-health outcomes, while partial analyses-where outcomes are considered separately, with their joint relationship under uncertainty ignored-lead to incorrect inference regarding preferred strategies.

OBJECTIVE: The objective of this paper is to consider whether such decision making can be better informed with alternative presentation and summary measures, extending methods previously shown to have advantages in multiple strategy comparison.

METHODS: Multiple outcomes CEA of a home-based palliative care model (PEACH) relative to usual care is undertaken in cost disutility (CDU) space and compared with analysis on the cost-effectiveness plane. Summary measures developed for comparing strategies across potential threshold values for multiple outcomes include: expected net loss (ENL) planes quantifying differences in expected net benefit; the ENL contour identifying preferred strategies minimising ENL and their expected value of perfect information; and cost-effectiveness acceptability planes showing probability of strategies minimising ENL.

RESULTS: Conventional analysis suggests PEACH is cost-effective when the threshold value per additional day at home ( 1) exceeds $1,068 or dominated by usual care when only the proportion of home deaths is considered. In contrast, neither alternative dominate in CDU space where cost and outcomes are jointly considered, with the optimal strategy depending on threshold values. For example, PEACH minimises ENL when 1=$2,000 and 2=$2,000 (threshold value for dying at home), with a 51.6% chance of PEACH being cost-effective.

CONCLUSION: Comparison in CDU space and associated summary measures have distinct advantages to multiple domain comparisons, aiding transparent and robust joint comparison of costs and multiple effects under uncertainty across potential threshold values for effect, better informing net benefit assessment and related reimbursement and research decisions.
Language eng
DOI 10.1371/journal.pone.0115544
Field of Research 111799 Public Health and Health Services not elsewhere classified
MD Multidisciplinary
Socio Economic Objective 0 Not Applicable
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30093401

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.