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Value Health. 2019 May;22(5):611-618. doi: 10.1016/j.jval.2019.02.008.

"Time Traveling Is Just Too Dangerous" but Some Methods Are Worth Revisiting: The Advantages of Expected Loss Curves Over Cost-Effectiveness Acceptability Curves and Frontier.

Author information

1
Drug Policy Program, Center for Research and Teaching in Economics (CIDE)-CONACyT, Aguascalientes, Mexico. Electronic address: fernando.alarid@cide.edu.
2
Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
3
Department of Health Promotion and Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
4
Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.

Abstract

BACKGROUND:

Cost-effectiveness acceptability curves (CEACs) and the cost-effectiveness acceptability frontier (CEAF) are the recommended graphical representations of uncertainty in a cost-effectiveness analysis (CEA). Nevertheless, many limitations of CEACs and the CEAF have been recognized by others. Expected loss curves (ELCs) overcome these limitations by displaying the expected foregone benefits of choosing one strategy over others, the optimal strategy in expectation, and the value of potential future research all in a single figure.

OBJECTIVES:

To revisit ELCs, illustrate their benefits using a case study, and promote their adoption by providing open-source code.

METHODS:

We used a probabilistic sensitivity analysis of a CEA comparing 6 cerebrospinal fluid biomarker test-and-treat strategies in patients with mild cognitive impairment. We showed how to calculate ELCs for a set of decision alternatives. We used the probabilistic sensitivity analysis of the case study to illustrate the limitations of currently recommended methods for communicating uncertainty and then demonstrated how ELCs can address these issues.

RESULTS:

ELCs combine the probability that each strategy is not cost-effective on the basis of current information and the expected foregone benefits resulting from choosing that strategy (ie, how much is lost if we recommended a strategy with a higher expected loss). ELCs display how the optimal strategy switches across willingness-to-pay thresholds and enables comparison between different strategies in terms of the expected loss.

CONCLUSIONS:

ELCs provide a more comprehensive representation of uncertainty and overcome current limitations of CEACs and the CEAF. Communication of uncertainty in CEA would benefit from greater adoption of ELCs as a complementary method to CEACs, the CEAF, and the expected value of perfect information.

KEYWORDS:

cost-effectiveness analysis; expected losses; probabilistic sensitivity analysis; uncertainty analysis; value of information analysis

PMID:
31104743
PMCID:
PMC6530578
[Available on 2020-05-01]
DOI:
10.1016/j.jval.2019.02.008
[Indexed for MEDLINE]

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