Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Spotting the Differences: The CEAC vs. CEAFC vs. CERAC

Version 1 : Received: 3 September 2021 / Approved: 3 September 2021 / Online: 3 September 2021 (10:23:49 CEST)

How to cite: Sendi, P.; Matter-Walstra, K.; Schwenkglenks, M. Spotting the Differences: The CEAC vs. CEAFC vs. CERAC. Preprints 2021, 2021090055 (doi: 10.20944/preprints202109.0055.v1). Sendi, P.; Matter-Walstra, K.; Schwenkglenks, M. Spotting the Differences: The CEAC vs. CEAFC vs. CERAC. Preprints 2021, 2021090055 (doi: 10.20944/preprints202109.0055.v1).

Abstract

Methods to handle uncertainty in economic evaluation have gained much attention in the literature and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarize and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some researchers have emphasized the limitations of the CEAC for informing decision and policy makers as the CEAC is insensitive to radial shifts of the joint distribution of incremental costs and effects in the North-East and South-West quadrants of the cost-effective plane (CEP). Furthermore, it has been pointed out that the CEAC does not incorporate risk-aversion in valuing uncertain costs and effects. In the present article we show that the cost-effectiveness affordability curve (CEAFC) captures both dimensions of the joint distribution of incremental costs and effects on the CEP and is therefore sensitive to radial shifts of the joint distribution on the CEP. Furthermore, the CEAFC also informs about the budget impact of a new intervention as it estimates the joint probability an intervention is both affordable and cost-effective. Moreover, we show that the cost-effectiveness risk-aversion curve (CERAC) allows to incorporate risk-aversion into the analysis and can therefore be used to inform decision-makers who are risk-averse. We use data from a published cost-effectiveness model of palbociclib in addition to letrozole versus letrozole alone for the treatment of oestrogen-receptor positive, HER-2 negative, advanced breast cancer to demonstrate the differences between CEAC, CEAFC and CERAC and show how these can jointly be used to inform decision and policy makers.

Keywords

economic evaluation; cost-effectiveness analysis; risk-aversion; budget impact; uncertainty; health care costs; health outcomes

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