Main outcome measures Cardiovascular events avoided, quality adjusted life years gained, and savings in healthcare costs for a given effectiveness; estimates of how much it would be worth spending to achieve a specific outcome.
The frontier follows the curve of the treatment with the highest expected net benefit for a given value of the cost-effectiveness threshold.
The cost-effectiveness of age screening and 5-year Framingham screening is similar in all the examples for a given annual treatment cost (for example, about £2,000 per CVD-free life year gained for age screening and £2,200 for Framingham screening if a Framingham screen costs £150 and the annual cost of preventive treatment is £200).
Because the participation fractions varied widely across countries, locally conducted trials are necessary to estimate the likely effect and cost effectiveness for a given country.
Our economic analysis revealed that treating all CHC patients without testing for fibrosis stage was the most cost-effective strategy given a cost-effectiveness threshold of £20,000.
6 Briefly, it shows the probability that the preferred option is cost effective for any given threshold incremental cost effectiveness ratio for all but a few replications and the few account for a negligible probability.
The net health benefit acceptability curve shows the proportion of trials that attained cost-effectiveness for a given strategy for willingness-to-pay thresholds up to $200,000/QALY.
43 This is illustrated on the cost effectiveness acceptability frontier (fig 5), which shows the probability that the strategy with the highest expected net monetary benefit is cost effective for a given willingness to pay for health outcomes.
Decision uncertainty was represented by plotting all results on the cost-effectiveness plane and by using the cost effectiveness acceptability curve, which illustrates the probability that MRI screening is cost-effective for a given range of willingness to pay values [ 29].
These estimates give an incremental cost effectiveness ratio of £1900£38/0.0202) per QALY gained for usual care compared with the decision support package, suggesting that the decision support intervention would not be cost-effective.
However, the studies disagreed as to which screening method was most effective or had the best incremental cost-effectiveness ratio for a given willingness to pay per life-year gained.
