Incremental net benefit in randomized clinical trials

There are three approaches to health economic evaluation for comparing two therapies. These are (i) cost minimization, in which one assumes or observes no difference in effectiveness, (ii) incremental cost-effectiveness, and (iii) incremental net benefit. The latter can be expressed either in units of effectiveness or costs. When analysing data from a clinical trial, expressing incremental net benefit in units of cost allows the investigator to examine all three approaches in a single graph, complete with the corresponding statistical inferences. Furthermore, if costs and effectiveness are not censored, this can be achieved using common two-sample statistical procedures. The above will be illustrated using two examples, one with censoring and one without.

[1]  A A Stinnett,et al.  Net Health Benefits , 1998, Medical decision making : an international journal of the Society for Medical Decision Making.

[2]  S. Stearns,et al.  Estimating confidence intervals for cost-effectiveness ratios: an example from a randomized trial. , 1996, Statistics in medicine.

[3]  Morris Meisner,et al.  Power and Sample Size in Cost- Effectiveness Analysis , 1999, Medical decision making : an international journal of the Society for Medical Decision Making.

[4]  D Polsky,et al.  Confidence intervals for cost-effectiveness ratios: a comparison of four methods. , 1997, Health economics.

[5]  A R Willan,et al.  Economic evaluation of chemotherapy with mitoxantrone plus prednisone for symptomatic hormone-resistant prostate cancer: based on a Canadian randomized trial with palliative end points. , 1998, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[6]  Bernie J. O'Brien,et al.  In Search of Power and Significance: Issues in the Design and Analysis of Stochastic Cost-Effectiveness Studies in Health Care , 1994, Medical care.

[7]  A R Willan,et al.  Confidence intervals for cost-effectiveness ratios: an application of Fieller's theorem. , 1996, Health economics.

[8]  P. Wakker,et al.  Confidence intervals for cost/effectiveness ratios. , 1995, Health economics.

[9]  Anastasios A. Tsiatis,et al.  A consistent estimator for the distribution of quality adjusted survival time , 1997 .

[10]  Elwood Jm,et al.  Examining survival data. , 1979 .

[11]  D. Osoba,et al.  Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer: a Canadian randomized trial with palliative end points. , 1996, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  C E Phelps,et al.  On the (Near) Equivalence of Cost-Effectiveness and Cost-Benefit Analyses , 1991, International Journal of Technology Assessment in Health Care.

[13]  A H Briggs,et al.  Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. , 1997, Health economics.

[14]  D. Lin,et al.  Linear regression analysis of censored medical costs. , 2000, Biostatistics.

[15]  J Mullahy What you don't know can't hurt you? Statistical issues and standards for medical technology evaluation. , 1996, Medical care.

[16]  A R Willan,et al.  Power function arguments in support of an alternative approach for analyzing management trials. , 1994, Controlled clinical trials.

[17]  E. Feuer,et al.  Estimating medical costs from incomplete follow-up data. , 1997, Biometrics.

[18]  R. Gill Large Sample Behaviour of the Product-Limit Estimator on the Whole Line , 1983 .

[19]  M Johannesson,et al.  A Note on Confidence Intervals in Cost-Effectiveness Analysis , 1998, International Journal of Technology Assessment in Health Care.

[20]  R. Baltussen,et al.  The interpretation of results of economic evaluation: explicating the value of health. , 1997, Health economics.

[21]  M J Al,et al.  Costs, effects and C/E-ratios alongside a clinical trial. , 1994, Health economics.

[22]  Amiram Gafni,et al.  When Do the "Dollars" Make Sense? , 1996, Medical decision making : an international journal of the Society for Medical Decision Making.