Page 88 - Htain Manual

T
he first part of this chapter focuses on interpreting the evidence arising of an

economic evaluation in the form of incremental cost effectiveness ratio (ICER)

to undertake evidence based informed decision making with regard to

choosing between different health care interventions or programs. The second section gives
a basic understanding of the concept of sensitivity analysis undertaken to deal with

uncertainties arising consequent to the accuracy of parameter values and assumptions made

within a cost effectiveness analysis.

Interpreting evidence

Incremental cost effectiveness ratio (ICER) is the summary measure used to report

cost-effectiveness of competing interventions. It is defined as the ratio of the difference in

costs between two alternatives to the difference in effectiveness between the same two
alternatives. This ratio provides an intuitive metric, which is the incremental cost per unit of

health outcome for the intervention in question (usually newer or more recent health care

innovations) relative to its comparator and assists decision-makers in allocating resources
efficiently on those interventions that have been proven to yield best value for money.

The results of an economic evaluation are usually plotted on a graph known as cost

effectiveness plane (Fig 1). Cost effectiveness plane typically comprises of 4 quadrants, with

x-axis by convention representing difference in effects across the comparator interventions
and the vertical y-axis measuring difference in costs. Suppose we are comparing a new

chemotherapy regimen with an old one for a particular type of cancer. There can be four

possibilities, which can also be identified in the cost effectiveness plane. If the value of ICER

falls in the north-east quadrant, the newer treatment is more effective and also costs more.

In the south-east quadrant, the intervention of interest is both more effective as well as less
costly and thus, it dominates the old treatment. If ICER comes in north-west quadrant, the

opposite holds true, i.e., the newer intervention is more costly and less effective and is

dominated by the older treatment. Finally, the value of ICER in the south-west quadrant
represents that the new intervention is both less effective less costly. Most of the attention

is focused in NE quadrant, where it needs to be ascertained if the higher costs are justified by

the higher effects of the new intervention.

76