Estimating CE ratios under second-order uncertainty: The mean ratio versus the ratio of means

被引:94
作者
Stinnett, AA
Paltiel, AD
机构
[1] HARVARD UNIV,SCH PUBL HLTH,DEPT HLTH POLICY & MANAGEMENT,BOSTON,MA 02115
[2] HARVARD UNIV,SCH PUBL HLTH,HARVARD CTR RISK ANAL,BOSTON,MA 02115
关键词
cost-effectiveness analysis; mean ratio; ratio of means; second-order uncertainty;
D O I
10.1177/0272989X9701700414
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Two methods have been presented for estimating cost-effectiveness ratios under conditions of second-order (model) uncertainty: one method estimates a mean ratio of cost to effect (the ''mean ratio'' approach), and the other estimates a ratio of mean cost to mean effect (the ''ratio of means'' approach). However, the question of which estimate is theoretically correct has not been formally addressed. The authors show that the ''ratio of means'' approach follows directly from the theoretical foundations of cost-effectiveness analysis, has attractive internal consistency properties, and is consistent with a simple vector algebra approach to the problem. In contrast, the ''mean ratio'' approach has not been shown to follow from first principles, is internally inconsistent, and can prescribe economically inefficient choices. It is concluded that the ''ratio of means'' procedure should be preferred unless persuasive arguments are presented to the contrary.
引用
收藏
页码:483 / 489
页数:7
相关论文
共 7 条
[1]   Economic foundations of cost-effectiveness analysis [J].
Garber, AM ;
Phelps, CE .
JOURNAL OF HEALTH ECONOMICS, 1997, 16 (01) :1-31
[2]   ON THE DECISION RULES OF COST-EFFECTIVENESS ANALYSIS [J].
JOHANNESSON, M ;
WEINSTEIN, MC .
JOURNAL OF HEALTH ECONOMICS, 1993, 12 (04) :459-467
[3]  
MATCHAR DB, 1995, MED DECIS MAKING, V15, P420
[4]   Accounting for future costs in medical cost-effectiveness analysis [J].
Meltzer, D .
JOURNAL OF HEALTH ECONOMICS, 1997, 16 (01) :33-64
[5]  
Simon C., 1994, Mathematics for Economists
[6]   Mathematical programming for the efficient allocation of health care resources [J].
Stinnett, AA ;
Paltiel, AD .
JOURNAL OF HEALTH ECONOMICS, 1996, 15 (05) :641-653
[7]  
Weinstein M, 1973, J PUBLIC ECON, V2, P147, DOI [DOI 10.1016/0047-2727(73)90002-9, 10.1016/0047-2727(73)90002-9]