Incremental cost-effectiveness analysis: the optimal strategy depends on the strategy set.
Evaluating the incremental cost-effectiveness of a technology is critical to understanding the impact of its adoption. The purpose of this study was to evaluate, using a particular example, how the specific alternatives selected for a cost-effectiveness analysis may influence the results of the analysis. In this example, we analyzed the incremental cost-effectiveness of estriol screening for Down syndrome. Model assumptions of expected costs and effectiveness were based on previously published work involving four clinical strategies, including a "do nothing" (no screening) strategy. When the analysis started with all four strategies, two of the strategies could not be considered cost-effective because of extended dominance. However, when we eliminated the "do nothing" from the strategy set because of its clinical irrelevance, all three remaining strategies might be considered cost-effective from a policy perspective. We concluded that the incremental cost-effectiveness of clinical strategies could be strongly affected by the starting point for the analysis.
University of Texas M.D. Anderson Cancer Center, Department of Medical Specialties, Houston 77030-4095, USA.
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D000328:Adult; D000649:Amniocentesis / Q000191:economics*; D002140:California; D006063:Chorionic Gonadotropin / Q000032:analysis; D003362:Cost-Benefit Analysis / Q000379:methods*; D004314:Down Syndrome / Q000175:diagnosis*; D004964:Estriol / Q000032:analysis; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D008423:Maternal Age; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D013673:Technology Assessment, Biomedical / Q000191:economics*; D000509:alpha-Fetoproteins / Q000032:analysis
D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D004964:Estriol