INTEGRATING PATIENT PREFERENCES IN EFFICIENCY FRONTIER ANALYSES USING THE ANALYTIC HIERARCHY PROCESS

Author(s)

Hummel JM1, Steuten L2, Van Til J2, IJzerman MJ11University Twente, Enschede, Netherlands, 2University of Twente, Enschede, Netherlands

OBJECTIVES: In comparative effectiveness research and economic evaluations, benefits of technologies are measured using multiple outcomes measures. Information lacks however about the importance of these endpoints for patients. We propose a new methodology to integrate patient weighted outcomes in a cost-efficiency frontier. We illustrate this methodology by means of an efficiency frontier analysis of five alternative treatments of patients with equinovarus deformity poststroke. METHODS: The Analytic Hierarchy Process (AHP) is a technique for multi-criteria analysis. The AHP supported 140 patients to prioritize the outcome measures of treatments of equinovarus deformity poststroke, and 10 professionals to prioritize the treatments regarding the outcome measures. These outcome measures include functional outcomes, risk and side effects, comfort, daily effort, cosmetics, and impact of the treatment. Sensitivity analysis is based on bootstrapping of the participants’ priorities. Relative costs include the device related costs and the care related costs of the treatments.   RESULTS: The overall effectiveness of soft-tissue surgery (.41) is ranked first, followed by orthopedic footwear (.18), ankle-foot orthosis (.15), surface electrostimulation (.14), and finally implanted electrostimulation (.12). Implanted electrostimulation (.35) and soft-tissue surgery (.34) are considered to be most expensive, followed by surface electrostimulation (.26), orthopedic footwear (.03) and ankle-foot orthosis (.02). Based on these priorities of the treatments’ overall effectiveness and costs, an efficiency frontier was drawn that includes decision uncertainty. CONCLUSIONS: The results suggest that the cost-effectiveness of implanted electrostimulation and surface electrostimulation are unfavourable. This new methodology for efficiency frontier analysis allows decision makers to integrate the outcomes about the diverse values and costs of health care technology, and can be applied broadly. It is particularly suitable in the field of early technology assessment, since the AHP supports a systematic estimation of priors about the effectiveness of alternative treatments.

Conference/Value in Health Info

2010-11, ISPOR Europe 2010, Prague, Czech Republic

Value in Health, Vol. 13, No. 7 (November 2010)

Code

PCV139

Topic

Economic Evaluation

Topic Subcategory

Cost/Cost of Illness/Resource Use Studies

Disease

Cardiovascular Disorders

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