title: A Bayesian approach to stochastic cost-effectiveness analysis. An illustration and application to blood pressure control in type 2 diabetes.
abstract: The aim of this paper is to discuss the use of Bayesian methods in cost-effectiveness analysis (CEA) and the common ground between Bayesian and traditional frequentist approaches. A further aim is to explore the use of the net benefit statistic and its advantages over the incremental cost-effectiveness ratio (ICER) statistic. In particular, the use of cost-effectiveness acceptability curves is examined as a device for presenting the implications of uncertainty in a CEA to decision makers. Although it is argued that the interpretation of such curves as the probability that an intervention is cost-effective given the data requires a Bayesian approach, this should generate no misgivings for the frequentist. Furthermore, cost-effectiveness acceptability curves estimated using the net benefit statistic are exactly equivalent to those estimated from an appropriate analysis of ICERs on the cost-effectiveness plane. The principles examined in this paper are illustrated by application to the cost-effectiveness of blood pressure control in the U.K. Prospective Diabetes Study (UKPDS 40). Due to a lack of good-quality prior information on the cost and effectiveness of blood pressure control in diabetes, a Bayesian analysis assuming an uninformative prior is argued to be most appropriate. This generates exactly the same cost-effectiveness results as a standard frequentist analysis.
authors.affiliation: University of Oxford.
authors.forename: A H
authors.initials: AH
authors.lastname: Briggs
mesh_terms: D001499:Bayes Theorem; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis / Q000379:methods*; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000191:economics* / Q000517:prevention & control*; D013269:Stochastic Processes; D026712:Value of Life