title: Output correlations in probabilistic models with multiple alternatives.
abstract: A comprehensive cost-effectiveness decision model will often go beyond a one-to-one comparison and will include a number of competing alternatives. Only a simultaneous assessment of all relevant treatment alternatives avoids comparing average cost-effectiveness ratios and allows a truly incremental analysis. Two issues arise if the analysis is probabilistic, namely, the occurrence of output correlations and difficulty in presenting the results. I have examined the role of output correlations using a screening model with eight alternatives and have shown that specifically cost-cost and quality-adjusted life years (QALY)-QALY correlations between alternatives have a major impact on decision uncertainty, as measured by the probability of the cost-effectiveness and expected value of perfect information. In particular, the latter strongly depends on between-alternative output correlations. This analysis shows that both the expected value of perfect information plots and acceptability curves/frontiers are sensitive to output correlations and thus appropriate for presentation of multiple alternatives. To avoid confusing statistical significance and economic importance I propose that acceptability curves be augmented by incremental net-benefit density plots at a given willingness to pay threshold.
authors.affiliation: Lek Pharmaceuticals d.d., Sandoz Development Center, Verovskova 57, 1000, Ljubljana, Slovenia, klemen.naversnik@gmail.com.
authors.forename: Klemen
authors.initials: K
authors.lastname: Naveršnik
mesh_terms: D003362:Cost-Benefit Analysis; D017059:Models, Econometric; D015233:Models, Statistical; D019057:Quality-Adjusted Life Years; D013673:Technology Assessment, Biomedical / Q000379:methods*