RISK-BENEFIT ASSESSMENT USING THE LIKELIHOOD HELPED OR HARMED RATIO- SIMILARITIES AND DIFFERENCES WITH INCREMENTAL COST-EFFECTIVENESS RATIOS

Author(s)

O'Day K, Meyer KL
Xcenda, LLC, Palm Harbor, FL, USA

Objective: Risk-benefit assessment involves tradeoffs between the potential clinical benefits and the potential harms of treatment. The number-needed-to-treat (NNT) is a measure used to quantify the potential benefit, while the number-needed-to-harm (NNH) is used to quantify the potential harm. Together, these metrics can be used to generate a likelihood helped or harmed (LHH) ratio, defined as 1/(NNT/NNH). We show how the LHH ratio is functionally equivalent to incremental cost-effectiveness ratios (ICERs) and can be utilized by health economists to conduct risk-benefit analyses. Concept: ICERs quantify tradeoffs between clinical benefit and economic cost to inform healthcare policy decision making. The ICER, as shown on a cost-effectiveness plane, represents the ratio of the difference in costs over the difference in effectiveness, with lower ICERs reflecting a treatment with a more favorable cost-benefit tradeoff. Similarly, risk-benefit assessment with the LHH ratio can be depicted on a risk-benefit plane, with the x-axis representing the benefit and the y-axis representing the risk. The distance between points on the x-axis represents the absolute benefit difference of a treatment while the distance between points on the y-axis represents the absolute risk difference of a treatment. The LHH ratio is the inverse of the slope of the line connecting the risk-benefit points of the two treatments, with higher LHH ratio values representing a more favorable risk-benefit tradeoff. We provide a worked example using clinical data from a published meta-analysis, along with graphical representations, to show how to conduct risk-benefit analyses using the risk-benefit plane, and we discuss some similarities and differences with ICERs. Conclusion: LHH ratios are similar to ICERs and can provide a quantitative and visual framework that can be used to communicate potential risk-benefit tradeoffs. Health economists can employ their expertise and training to conduct risk-benefit analyses to help inform clinical and policy decision making.

Conference/Value in Health Info

2019-05, ISPOR 2019, New Orleans, LA, USA

Value in Health, Volume 22, Issue S1 (2019 May)

Code

PNS27

Topic

Clinical Outcomes, Epidemiology & Public Health, Health Technology Assessment

Topic Subcategory

Clinical Outcomes Assessment, Decision & Deliberative Processes

Disease

No Specific Disease

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