title: Using propensity scores to estimate the cost-effectiveness of medical therapies.
abstract: The cost-effectiveness ratio is a popular statistic that is used by policy makers to decide which programs are cost-effective in the public health sector. Recently, the net monetary benefit has been proposed as an alternative statistical summary measure to overcome the limitations associated with the cost-effectiveness ratio. Research on using the net monetary benefit to assess the cost-effectiveness of therapies in non-randomized studies has yet to be done. Propensity scores are useful in estimating adjusted effectiveness of programs that have non-randomized or quasi-experimental designs. This article introduces the use of propensity score adjustment in cost-effectiveness analyses to estimate net monetary benefits for non-randomized studies. The uncertainty associated with the net monetary benefit estimate is evaluated using cost-effectiveness acceptability curves. Our method is illustrated by applying it to SEER-Medicare data for muscle invasive bladder cancer to determine the most cost-effective treatment protocol.
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. aindurkh@hsph.harvard.edu
authors.forename: Alka
authors.initials: A
authors.lastname: Indurkhya
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis / Q000379:methods*; D015653:Cystectomy / Q000191:economics / Q000592:standards; D003627:Data Interpretation, Statistical; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008484:Medicaid; D018803:Models, Economic; D018426:SEER Program; D001749:Urinary Bladder Neoplasms / Q000191:economics / Q000601:surgery