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Cost effectiveness acceptability curves, counterfactuals and decision-theoretic approach to health economic evaluations

Cost effectiveness acceptability curves (CEACs) are established in Health Economics as one of the most important tools for implementing probabilistic sensitivity analysis, which has become an essential requisite of technology assessment studies and reimbursement decisions. The current consensus is that CEACs should be regarded as an obligatory component of comprehensive pharmacoeconomic evaluations. We argue that the theory upon which the definition of CEACs is built is logically flawed, because it relates to quantities that are counterfactual in nature: this has the consequence that some components of the cost effectiveness model simply can not be identified from empirical data (unless we make further assumptions that are themselves non-testable). Counterfactual-based theories do not bring any substantial improvements to the modelling procedure and are potentially misleading, and should be avoided for both logical and pragmatic reasons. We advocate an alternative, decision-theoretic, approach to health economics evaluations. This provides a soundly-based and more general framework, which does not need additional assumptions to guarantee the empirical identifiability of the relevant quantities.

Speaker

Speaker 1 Biography
Gianluca Baio is a Research Fellow in the Evidence program, and a Honorary Lecturer in the Department of Public Health and Policy, London School of Hygiene & Tropical Medicine. He has got a PhD in Applied Statistics from the University of Florence (Italy). His main interests are in Causal Inference using Probabilistic Expert Systems and Bayesian Networks with applications to Forensic Science, and in applied Bayesian Statistics in economic evaluation of health systems and for pharmacoeconomics analysis. 

Speaker 2 Biography
Philip Dawid is Professor of Statistics at Cambridge University, having been Pearson Professor of Statistics at University College London from 1989 to 2007. He is Chartered Statistician and Fellow of the Royal Statistical Society, which has awarded him Guy Medals in Bronze and Silver; elected Fellow of the Institute of Mathematical Statistics; elected Member of the International Statistical Institute; and a Member of the Organising Committee for the Valencia International Meetings on Bayesian Statistics. He has served as Editor of the Journal of the Royal Statistical Society (Series B) and of Biometrika, and is currently an Editor of Bayesian Analysis. He was President of the International Society for Bayesian Analysis for the year 2000.