title: Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of "community acquired" syncope.
abstract: BACKGROUND
  Cost-effectiveness acceptability curves (CEACs) describe the probability that a new treatment or intervention is cost-effective. The net benefit regression framework (NBRF) allows cost-effectiveness analysis to be done in a simple regression framework. The objective of the paper is to illustrate how net benefit regression can be used to construct a CEAC.
  
  
  METHODS
  One hundred patients referred for ambulatory monitoring with syncope or presyncope were randomized to a one-month external loop recorder (n = 49) or 48-hour Holter monitor (n = 51). The primary endpoint was symptom-rhythm correlation during monitoring. Direct costs were calculated based on the 2003 Ontario Health Insurance Plan (OHIP) fee schedule combined with hospital case costing of labour, materials, service and overhead costs for diagnostic testing and related equipment.
  
  
  RESULTS
  In the loop recorder group, 63.27% of patients (31/49) had symptom recurrence and successful activation, compared to 23.53% in the Holter group (12/51). The cost in US dollars for loop recording was 648.50 dollars and 212.92 dollars for Holter monitoring. The incremental cost-effectiveness ratio (ICER) of the loop recorder was 1,096 dollars per extra successful diagnosis. The probability that the loop recorder was cost-effective compared to the Holter monitor was estimated using net benefit regression and plotted on a CEAC. In a sensitivity analysis, bootstrapping was used to examine the effect of distributional assumptions.
  
  
  CONCLUSIONS
  The NBRF is straightforward to use and interpret. The resulting uncertainty surrounding the regression coefficient relates to the CEAC. When the link from the regression's p-value to the probability of cost-effectiveness is tentative, bootstrapping may be used.
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Canada. jeffrey.hoch@utoronto.ca
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hoch
authors.forename: Marie Antoinette
authors.initials: MA
authors.lastname: Rockx
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
mesh_terms: D001499:Bayes Theorem; D003362:Cost-Benefit Analysis / Q000379:methods*; D015716:Electrocardiography, Ambulatory / Q000191:economics* / Q000295:instrumentation; D005245:Fee Schedules; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D009313:National Health Programs / Q000191:economics; D009864:Ontario; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D013575:Syncope / Q000175:diagnosis* / Q000191:economics / Q000473:pathology; D013637:Tape Recording / Q000191:economics