The use of an uncertainty framework, in which cost-effectiveness estimates for multiple interventions are presented in terms of their probability of being cost-effective at different budget levels, provides decision-makers with policy-relevant data on the choices to be made under conditions of resource expansion (or reduction) [ 23, 24].
"The methods by which cost-effectiveness is evaluated are very poor," says John Zajicek, professor of clinical neuroscience at the University of Plymouth.
The level at which cost-effectiveness is considered to be achieved depends on arbitrary decisions related to the fiscal resources and perspective of the purchaser.
This paper looks at Thailand's publicly-funded antiretroviral initiative which was first introduced in 1992, and explores the extent to which cost-effectiveness evidence influenced policy.
An exception herein is an economic evaluation study alongside the Dutch non-experimental study mentioned before, in which cost-effectiveness of different treatment modalities for both cluster B and C PDs is assessed [ 35, 36].
Uncertainty around cost-effectiveness ratios will be dealt with in probabilistic sensitivity analysis in which costs and health outcomes will be bootstrapped and plotted on cost-effectiveness planes from which cost-effectiveness acceptability curves will be drawn [ 47- 49].
We had hoped to learn the extent to which cost-effectiveness depends on the strength or scale of implementation, or country-specific factors, and each of these considerations is salient for the transferability of study results.
Other allocative criteria against which cost-effectiveness arguments need to be considered include the relative severity and the extent of spillover effects among different diseases, the potential for reducing catastrophic household spending on health, and protection of human rights [ 12, 13, 18, 30, 31, 41].
15 16 Markov models define diseases using clinically relevant and economically important health states, between which patients move based on the natural history of the disease, and to which cost and effectiveness outcomes are ascribed.
The National Institute for Clinical Excellence, which measures the cost effectiveness of new drugs and treatments and has the power to restrict their use on the NHS, will be given a more independent role.
