A multi-criteria decision analysis perspective on the health economic evaluation of medical interventions
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A standard practice in health economic evaluation is to monetize health effects by assuming a certain societal willingness-to-pay per unit of health gain. Although the resulting net monetary benefit (NMB) is easy to compute, the use of a single willingness-to-pay threshold assumes expressibility of the health effects on a single non-monetary scale. To relax this assumption, this article proves that the NMB framework is a special case of the more general stochastic multi-criteria acceptability analysis (SMAA) method. Specifically, as SMAA does not restrict the number of criteria to two and also does not require the marginal rates of substitution to be constant, there are problem instances for which the use of this more general method may result in a better understanding of the trade-offs underlying the reimbursement decision-making problem. This is illustrated by applying both methods in a case study related to infertility treatment.
KeywordsHealth economic evaluation Multi-criteria decision analysis Infertility treatment
JEL ClassificationC44 I18
This research was conducted within the framework of the Center for Translational Molecular Medicine, project PREDICCt (grant 01C-104) and supported by the Dutch Heart Foundation, Dutch Diabetes Research Foundation, and Dutch Kidney Foundation.
- 3.Briggs, A.H., Claxton, K., Sculpher, M.: Decision modelling for health economic evaluation. Oxford University Press, Oxford (2006)Google Scholar
- 6.Claxton, K., Posnett, J.: An economic approach to clinical trial design and research priority-setting. Health Econ. 5(6), 513–524 (1998). doi: 10.1002/(SICI)1099-1050(199611)5:6<513::AID-HEC237>3.0.CO;2-9 CrossRefGoogle Scholar
- 8.Drummond, M., Sculpher, M., Torrance, G., O’Brien, B., Stoddart, G.: Methods for the economic evaluation of health care programmes. Oxford University Press, New York (2005)Google Scholar
- 9.Eichler, H., Kong, S., Gerth, W., Mavros, P., Jönsson, B.: Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge? Value in Health 7(5), 518–528 (2004). doi: 10.1111/j.1524-4733.2004.75003.x PubMedCrossRefGoogle Scholar
- 12.Fiddelers, A.A.A., Dirksen, C.D., Dumoulin, J., van Montfoort, A., Land, J.A., Janssen, J.M., Evers, J.L.H., Severens, J.L.: Cost-effectiveness of seven IVF strategies: results of a Markov decision-analytic model. Hum. Reprod. 24(7), 1648–1655 (2009). doi: 10.1093/humrep/dep041 PubMedCrossRefGoogle Scholar
- 13.Goetghebeur, M., Wagner, M., Khoury, H., Levitt, R., Erickson, L., Rindress, D.: Bridging health technology assessment (HTA) and efficient health care decision making with multicriteria decision analysis (MCDA): applying the evidem framework to medicines appraisal. Med. Decis. Making 32(2), 376–388 (2012). doi: 10.1177/0272989X11416870 PubMedCrossRefGoogle Scholar
- 14.Keeney, R., Raiffa, H.: Decisions with multiple objectives: preferences and value tradeoffs. Wiley, New York (1976)Google Scholar