title: The Probabilistic Efficiency Frontier: A Framework for Cost-Effectiveness Analysis in Germany Put into Practice for Hepatitis C Treatment Options.
abstract: The German Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) adapted the efficiency frontier (EF) approach to conform to statutory provisions on cost-effectiveness analysis of health technologies. EF serves as a framework for evaluating cost-effectiveness and indirectly for pricing and reimbursement decisions.
  
  
  
  To calculate an EF on the basis of single multidimensional benefit by taking patient preferences and uncertainty into account; to evaluate whether EF is useful to inform decision makers about cost-effectiveness of new therapies; and to find whether a treatment is efficient at given prices demonstrated through a case study on chronic hepatitis C.
  
  
  
  A single multidimensional benefit was calculated by linear additive aggregation of multiple patient-relevant end points. End points were identified and weighted by patients in a previous discrete-choice experiment (DCE). Aggregation of overall benefit was ascertained using preferences and clinical data. Monte-Carlo simulation was applied. Uncertainty was addressed by price acceptability curve (PAC) and net monetary benefit (NMB).
  
  
  
  The case study illustrates that progress in benefit and efficiency of hepatitis C virus treatments could be depicted very well with the EF. On the basis of cost, effect, and preference data, the latest generations of interferon-free treatments are shown to yield a positive NMB and be efficient at current prices.
  
  
  
  EF was implemented taking uncertainty into account. For the first time, a DCE was used with the EF. The study shows how DCEs in combination with EF, PAC, and NMB can contribute important information in the course of reimbursement and pricing decisions.
authors.affiliation: Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Neubrandenburg, Germany. Electronic address: muehlbacher@hs-nb.de.
authors.forename: Axel C
authors.initials: AC
authors.lastname: Mühlbacher
authors.affiliation: Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Neubrandenburg, Germany.
authors.forename: Andrew
authors.initials: A
authors.lastname: Sadler
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017850:Economics, Pharmaceutical; D005858:Germany; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D016014:Linear Models; D057240:Patient Preference; D011787:Quality of Health Care; D013673:Technology Assessment, Biomedical / Q000379:methods*
chemical_list: D000998:Antiviral Agents
keywords: cost-effectiveness analysis; efficiency frontier (EF); hepatitis C; multiple criteria decision analysis (MCDA); net monetary benefit (NMB); patient preferences; price acceptability curve (PAC)