Bayesian estimation, simulation and uncertainty analysis: the cost-effectiveness of ganciclovir prophylaxis in liver transplantation.
This paper demonstrates the usefulness of combining simulation with Bayesian estimation methods in analysis of cost-effectiveness data collected alongside a clinical trial. Specifically, we use Markov Chain Monte Carlo (MCMC) to estimate a system of generalized linear models relating costs and outcomes to a disease process affected by treatment under alternative therapies. The MCMC draws are used as parameters in simulations which yield inference about the relative cost-effectiveness of the novel therapy under a variety of scenarios. Total parametric uncertainty is assessed directly by examining the joint distribution of simulated average incremental cost and effectiveness. The approach allows flexibility in assessing treatment in various counterfactual premises and quantifies the global effect of parametric uncertainty on a decision-maker's confidence in adopting one therapy over the other.
Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota 55905, USA. vanness.david@mayo.edu
David J
DJ
Vanness
W Ray
WR
Kim
D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics; D001499:Bayes Theorem; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003586:Cytomegalovirus Infections / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage* / Q000191:economics; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics / Q000276:immunology*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011292:Premedication / Q000191:economics*; D011336:Probability; D012307:Risk Factors; D016896:Treatment Outcome
D000998:Antiviral Agents; D015774:Ganciclovir