title: Nonparametric inference for time-dependent incremental cost-effectiveness ratios.
abstract: As the costs of medical care increase, more studies are evaluating cost in addition to effectiveness of treatments. Cost-effectiveness analyses in randomized clinical trials have typically been conducted only at the end of follow-up. However, cost-effectiveness may change over time. We therefore propose a nonparametric estimator to assess the incremental cost-effectiveness ratio over time. We also derive the asymptotic variance of our estimator and present formulation of Fieller-based simultaneous confidence bands. Simulation studies demonstrate the performance of our point estimators, variance estimators, and confidence bands. We also illustrate our methods using data from a randomized clinical trial, the second Multicenter Automatic Defibrillator Implantation Trial. This trial studied the effects of implantable cardioverter-defibrillators on patients at high risk for cardiac arrhythmia. Results show that our estimator performs well in large samples, indicating promising future directions in the field of cost-effectiveness. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, 98195, U.S.A.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Yee
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, 98195, U.S.A.
authors.forename: Kwun Chuen
authors.initials: KC
authors.lastname: Gary Chan
mesh_terms: D056808:Biostatistics; D003198:Computer Simulation; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D006801:Humans; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic / Q000191:economics / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D016019:Survival Analysis
keywords: Fieller bands; cost-effectiveness analysis; induced informative censoring; nonparametric estimation; randomized clinical trials; survival analysis