title: A multi-criteria decision analysis perspective on the health economic evaluation of medical interventions.
abstract: A standard practice in health economic evaluation is to monetize health effects by assuming a certain societal willingness-to-pay per unit of health gain. Although the resulting net monetary benefit (NMB) is easy to compute, the use of a single willingness-to-pay threshold assumes expressibility of the health effects on a single non-monetary scale. To relax this assumption, this article proves that the NMB framework is a special case of the more general stochastic multi-criteria acceptability analysis (SMAA) method. Specifically, as SMAA does not restrict the number of criteria to two and also does not require the marginal rates of substitution to be constant, there are problem instances for which the use of this more general method may result in a better understanding of the trade-offs underlying the reimbursement decision-making problem. This is illustrated by applying both methods in a case study related to infertility treatment.
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands, d.postmus@umcg.nl.
authors.forename: Douwe
authors.initials: D
authors.lastname: Postmus
authors.forename: Tommi
authors.initials: T
authors.lastname: Tervonen
authors.forename: Gert
authors.initials: G
authors.lastname: van Valkenhoef
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods*; D003661:Decision Support Techniques; D004469:Economics, Hospital / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007246:Infertility / Q000191:economics / Q000628:therapy; D017059:Models, Econometric; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D013269:Stochastic Processes