Practice: From cost utility to clinical cost benefit

Most health economists have probably faced a situation where ICER, CEEF, CEAF, EVPI or some other complicated cost-utility analysis outcome do not alone make the case in practical value demonstration and decision making for the clinics. In many cases, elaboration of cost-effectiveness towards clinical outcomes, clinical value analysis and clinical cost-benefit analysis is needed.

In a recent published article “a type of clinical value analysis… increased the clinical interpretation and appeal of modeled outcomes by including both relative and absolute (impact investment…) benefit assessments”. This was done in order to elaborate and improve the practical applications of comprehensive cost-utility results in decision making. In the Supplementary Material G where, as examples,

  • clinical cost-benefit analysis (CCBA) approach was used to demonstrate the cost-effectiveness and clinical value simultaneously (Figures G1 and G3) for easier and wider decision making,
  • Bayesian treatment ranking (BTR) was used to rank the treatments in terms of their cost-effectiveness in order to assess directly the uncertainty related to ICERs and report the best treatments in a straightforward fashion, and
  • impact investment analysis (IIA, Figure G4) with a fixed budget demonstrated the clinical value gained (investment impact) with different treatment options in simple fashion without any complicated outcomes.
Source: Soini E, Hautala A, Poikonen E, Becker U, Kyttälä M, Martikainen J. Cost-Effectiveness of First-Line Chronic Lymphocytic Leukemia Treatments When Full-Dose Fludarabine Is Unsuitable. Clin Ther. 2016 Mar 9. pii: S0149-2918(16)30056-X. doi: 10.1016/j.clinthera.2016.02.005. [Epub ahead of print]. Link.
Further information: Erkki Soini