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Among the three IUI modalities, C-IUI (with the lowest LBR) had the worst cost-effectiveness ratio and the worst ICER.
When assuming that LBR of IUI (any modality) was decreasing with cycle order, all above scenarios showed consistently similar results, with higher cost and worst cost-effectiveness and ICER values for "IUI+IVF" compared to IVF only.
The median incremental cost-effectiveness ratio was 16,000 euros per quality-adjusted life year (QALY) (range, 10,000 88,000), with the worst cost-effectiveness occurring when recommended stop rules for nonresponding patients were not applied.
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Values tested reflected worst-case scenarios (i.e., decreasing cost-effectiveness of surgical therapy) and are described in Tables 1 and 2. The impact of combinations of variables likely to be related were tested, including 1) combining all intervention costs in worst-case scenarios and 2) combining intervention effect and duration of diabetes remission in worst-case scenarios.
However, they are currently the 'least worst' common denominators that facilitate a comparison of cost-effectiveness of ECND interventions.
One-way sensitivity analyses were performed to establish cost-effectiveness threshold values and the worst-case scenario.
7 In a worst-case scenario, application of unadjusted utilities may lead to biased cost-effectiveness results and wrong decision-making.
The SF-6D is a validated health utility measure that is used to compare cost-effectiveness of different treatments and the value ranges from -0.11 (worst health) to 1.0 (perfect health) [ 19].
In these scenario analyses a strong variation of the cost-effectiveness results was obtained ranging from €23,512 (best case) to €176,958 (worst case) per QALY gained by AVD therapy.
The incremental cost-effectiveness ratio for zofenopril versus ramipril was 2125.45 Euros per event prevented (worst and best case scenario in the sensitivity analysis was 3590.09 and 3243.96 Euros, respectively).
Worst-case scenarios and deliberately conservative estimates reduce the utility of the risk estimate for cost-benefit or cost-effectiveness studies and decrease our ability to describe the uncertainty of the risk estimates.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com