Evidence map›Paper›PMID 31134467›Full record

ArticlePharmacoEconomics2019

Severity-Adjusted Probability of Being Cost Effective.

Matthijs M Versteegh, Isaac Corro Ramos, Nasuh C Buyukkaramikli, Amir Ansaripour, Vivian T Reckers-Droog, Werner B F Brouwer

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PharmacoEconomics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
46citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

46 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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  15. Cognitive behavioral therapy for psychosis: a cost-effectiveness study using the EPiSODe model.European psychiatry : the journal of the Association of European Psychiatrists · 2025
    Article
  16. Article
  17. Monetary value of health-a practical decision-making framework combining equity considerations and WTP.The European journal of health economics : HEPAC : health economics in prevention and care · 2025
    Article
  18. Article
  19. Article
  20. Framework for developing cost-effectiveness analysis threshold: the case of Egypt.The Journal of the Egyptian Public Health Association · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Matthijs M VersteeghInstitute for Medical Technology Assessment, Erasmus University of Rotterdam, Burgemeester Oudlaan 50, 3000 DR, Rotterdam, The Netherlands. versteegh@imta.eur.nl.ORCID 0000-0003-4804-235X
Isaac Corro RamosInstitute for Medical Technology Assessment, Erasmus University of Rotterdam, Burgemeester Oudlaan 50, 3000 DR, Rotterdam, The Netherlands.
Nasuh C BuyukkaramikliInstitute for Medical Technology Assessment, Erasmus University of Rotterdam, Burgemeester Oudlaan 50, 3000 DR, Rotterdam, The Netherlands.
Amir AnsaripourErasmus School of Health Policy & Management, Erasmus University of Rotterdam, Burgemeester Oudlaan 50, 3000 DR, Rotterdam, The Netherlands.
Vivian T Reckers-DroogErasmus School of Health Policy & Management, Erasmus University of Rotterdam, Burgemeester Oudlaan 50, 3000 DR, Rotterdam, The Netherlands.
Werner B F BrouwerErasmus School of Health Policy & Management, Erasmus University of Rotterdam, Burgemeester Oudlaan 50, 3000 DR, Rotterdam, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn the context of priority setting, a differential cost-effectiveness threshold can be used to reflect a higher societal willingness to pay for quality-adjusted life-year gains in the worse off. However, uncertainty in the estimate of severity can lead to problems when evaluating the outcomes of cost-effectiveness analyses.

objectivesThis study standardizes the assessment of severity, integrates its uncertainty with the uncertainty in cost-effectiveness results and provides decision makers with a new estimate: the severity-adjusted probability of being cost effective.

methodsSeverity is expressed in proportional and absolute shortfall and estimated using life tables and country-specific EQ-5D values. We use the three severity-based cost-effectiveness thresholds (€20.000, €50.000 and €80.000, per QALY) adopted in The Netherlands. We exemplify procedures of integrating uncertainty with a stylized example of a hypothetical oncology treatment.

resultsApplying our methods, taking into account the uncertainty in the cost-effectiveness results and in the estimation of severity identifies the likelihood of an intervention being cost effective when there is uncertainty about the appropriate severity-based cost-effectiveness threshold.

conclusionsHigher willingness-to-pay thresholds for severe diseases are implemented in countries to reflect societal concerns for an equitable distribution of resources. However, the estimates of severity are uncertain, patient populations are heterogeneous, and this can be accounted for with the severity-adjusted probability of being cost effective proposed in this study. The application to the Netherlands suggests that not adopting the new method could result in incorrect decisions in the reimbursement of new health technologies.

Indexed as

ProbabilityQuality-Adjusted Life YearsBiomedical TechnologyCost-Benefit AnalysisDecision MakingHumansNetherlandsReimbursement MechanismsSeverity of Illness IndexTechnology Assessment, BiomedicalUncertainty

Identifiers

PMID31134467
PMCPMC6830403

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.