title: Cost-effectiveness analysis when the WTA is greater than the WTP.
abstract: The incremental cost effectiveness ratio has long been the standard parameter of interest in the assessment of the cost-effectiveness of a new treatment. However, due to concerns with interpretability and statistical inference, authors have suggested using the willingness-to-pay for a unit of health benefit to define the incremental net benefit as an alternative. The incremental net benefit has a more consistent interpretation and is amenable to routine statistical procedures. These procedures rely on the fact that the willingness-to-accept compensation for a loss of a unit of health benefit (at some cost saving) is the same as the willingness-to-pay for it. Theoretical and empirical evidence suggest, however, that in health care the willingness-to-accept is about twice as much as the willingness-to-pay. We use Bayesian methods to provide a statistical procedure for the cost-effectiveness comparison of two arms of a randomized clinical trial that allows the willingness-to-pay and the willingness-to-accept to have different values. An example is provided.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University and Center for Evaluation of Medicines, St Joseph's Hospital, Hamilton, ON, Canada. willana@mcmaster.ca
authors.forename: A R
authors.initials: AR
authors.lastname: Willan
authors.forename: B J
authors.initials: BJ
authors.lastname: O'Brien
authors.forename: R A
authors.initials: RA
authors.lastname: Leyva
mesh_terms: D001499:Bayes Theorem; D001699:Biometry; D002986:Clinical Trials as Topic / Q000191:economics* / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000191:economics; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000191:economics