Cost-effectiveness acceptability curves - facts, fallacies and frequently asked questions

Fenwick, E., O'Brien, B.J. and Briggs, A. (2004) Cost-effectiveness acceptability curves - facts, fallacies and frequently asked questions. Health Economics, 13(5), pp. 405-415. (doi: 10.1002/hec.903)

Abstract

Cost-effectiveness acceptability curves (CEACs) have been widely adopted as a method to quantify and graphically represent uncertainty in economic evaluation studies of health-care technologies. However, there remain some common fallacies regarding the nature and shape of CEACs that largely result from the textbook illustration of the CEAC. This textbook CEAC shows a smooth curve starting at probability 0, with an asymptote to 1 for higher money values of the health outcome (). But this familiar ogive shape which makes the textbook CEAC look like a cumulative distribution function is just one special case of the CEAC. The reality is that the CEAC can take many shapes and turns because it is a graphic transformation from the cost-effectiveness plane, where the joint density of incremental costs and effects may straddle quadrants with attendant discontinuities and asymptotes. In fact CEACs: (i) do not have to cut the y-axis at 0; (ii) do not have to asymptote to 1; (iii) are not always monotonically increasing in ; and (iv) do not represent cumulative distribution functions (cdfs). Within this paper we present a gallery of CEACs in order to identify the fallacies and illustrate the facts surrounding the CEAC. The aim of the paper is to serve as a reference tool to accompany the increased use of CEACs within major medical journals.

• Item Type: Articles
• Keywords: cost-effectiveness acceptability curves, uncertainty, cost-effectiveness planes, decision-making
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Fenwick, Professor Elisabeth
• Authors: Fenwick, E., O'Brien, B.J., and Briggs, A.
• Subjects: R Medicine > RA Public aspects of medicine; R Medicine > R Medicine (General); H Social Sciences > HG Finance
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: Health Economics
• Publisher: John Wiley and Sons Ltd.
• ISSN: 1057-9230
• Copyright Holders: Copyright © 2004 John Wiley and Sons Ltd.
• First Published: First published in Health Economics 13(5):405-415
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher