JSM 2004 - Toronto

Abstract #301735

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Activity Number: 109
Type: Topic Contributed
Date/Time: Monday, August 9, 2004 : 10:30 AM to 12:20 PM
Sponsor: Section on Health Policy Statistics
Abstract - #301735
Title: The ICER Age: An Uncertain History
Author(s): Ahmed Bayoumi*+
Companies: St. Michael's Hospital
Address: Inner City Health Research Unit, Toronto, ON, M5B 1W8, Canada
Keywords: cost-effectiveness analysis ; confidence intervals ; Fieller's theorem ; ICER ; health economics ; graphical representations
Abstract:

The most common outcome measure used in cost-effectiveness analysis is the Incremental Cost-Effectiveness Ratio (ICER), which divides the difference in cost of two programs by the difference in effectiveness. Although popular, the ICER has two significant limitations. First, a sample ICER is a biased but consistent estimator of the true population ICER. Second, quantifying the uncertainty associated with a ratio statistic like the ICER can be difficult. When individual-level data are available, the most promising parametric method to calculate confidence bounds uses Fieller's theorem. Nonparametric bootstrap methods have also been advanced, along with methods for bias correction. Calculating confidence intervals for samples where the mean effectiveness is near zero presents particular challenges. Graphical representation of costs and outcomes on a cost-effectiveness plane are often helpful. The bivariate density of costs and effectiveness outcomes can be demonstrated with confidence ellipses or contour plots. Rays emanating from the origin can often be drawn to represent calculated confidence bounds.

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