Why Its Time to Abandon the ICER Dr Mike Paulden, Assistant - PowerPoint PPT Presentation

Why It’s Time to Abandon the ICER Dr Mike Paulden, Assistant Professor, School of Public Health, University of Alberta @mikepaulden paulden@ualberta.ca Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 1 mikepaulden.com +1 (844) PAULDEN

Introduction ● The incremental cost-effectiveness ratio (ICER) is widely used to report the results of economic analyses of health technologies ● Yet reporting ICERs is unnecessary - alternative measures exist, based on the concepts of net health benefit (NHB) or net monetary benefit (NMB) ● Yet ICERs remain popular with decision makers, and there is a common perception that there are advantages to using ICERs, particularly if the cost- effectiveness threshold (λ) is unknown ● This paper argues that this common perception is false - there are no advantages to using ICERs and many important limitations Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 2

Calculating ICERs where there are only two strategies Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 3

ICER = ∆Cost / ∆QALYs Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 4

Result: ICERs are easy to calculate with only two strategies Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 5

Interpreting the ICER where there are only two strategies Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 6

Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 7

Question: Is strategy B cost-effective ? Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 8

Question: Would a different strategy with an ICER of $25,000 per QALY be cost-effective? Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 10

Question: Would a different strategy with a negative ICER be cost-effective? Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 12

Question: Does a lower ICER imply that a strategy is necessarily more cost-effective ? Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 15

Limitations of ICERs in comparisons of two strategies 1. A threshold is required to determine whether a strategy is cost-effective , unless it is dominated/dominating (in which case an ICER is not required) 2. An ICER cannot be interpreted without also knowing the quadrant of the CE plane in which the strategy lies 3. Change in an ICER during a sensitivity analysis does not necessarily imply that the strategy is more or less cost-effective Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 19

Result: ICERs are difficult to interpret with only two strategies and any interpretation is limited Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 20

Calculating ICERs where there are multiple strategies Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 21

Strategy Cost QALYs A $600,000 24 B $1,300,000 34 C $400,000 16 D $500,000 26 E $700,000 20 F $100,000 6 G $1,000,000 30 H $350,000 8 Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 22

Step 1: Rank strategies by cost Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 23

Strategy Cost QALYs F $100,000 6 H $350,000 8 C $400,000 16 D $500,000 26 A $600,000 24 E $700,000 20 G $1,000,000 30 B 34 $1,300,000 Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 24

Step 2: Rule out ‘dominated’ strategies Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 25

Strategy Cost QALYs F $100,000 6 H $350,000 8 C $400,000 16 D $500,000 26 A $600,000 24 E $700,000 20 G $1,000,000 30 B $1,300,000 34 Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 26

Strategy Cost QALYs F $100,000 6 H $350,000 8 C $400,000 16 D $500,000 26 A $600,000 24 E $700,000 20 G $1,000,000 30 B $1,300,000 34 Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 27

Step 3: Calculate initial estimates of incremental values Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 28

ΔCost ΔQALYs Strategy Cost QALYs ICER F $100,000 6 H $350,000 8 C $400,000 16 D $500,000 26 A $600,000 24 D D D E $700,000 20 D D D G $1,000,000 30 B $1,300,000 34 Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 29

ΔCost ΔQALYs Strategy Cost QALYs ICER F $100,000 6 N/A N/A N/A H $350,000 8 C $400,000 16 D $500,000 26 A $600,000 24 D D D E $700,000 20 D D D G $1,000,000 30 B $1,300,000 34 Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 30

ΔCost ΔQALYs Strategy Cost QALYs ICER F $100,000 6 N/A N/A N/A H $350,000 8 $250,000 2 $125,000 C $400,000 16 $50,000 8 $6,250 D $500,000 26 $100,000 10 $10,000 A $600,000 24 D D D E $700,000 20 D D D G $1,000,000 30 $500,000 4 $125,000 B $1,300,000 34 $300,000 4 $75,000 Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 31

Step 4: Rule out initial ‘extendedly dominated’ strategies Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 32

ΔCost ΔQALYs Strategy Cost QALYs ICER F $100,000 6 N/A N/A N/A H $350,000 8 $250,000 2 $125,000 C $400,000 16 $50,000 8 $6,250 D $500,000 26 $100,000 10 $10,000 A $600,000 24 D D D E $700,000 20 D D D G $1,000,000 30 $500,000 4 $125,000 B $1,300,000 34 $300,000 4 $75,000 Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 33

ΔCost ΔQALYs Strategy Cost QALYs ICER F $100,000 6 N/A N/A N/A H $350,000 8 ED ED ED C $400,000 16 $50,000 8 $6,250 D $500,000 26 $100,000 10 $10,000 A $600,000 24 D D D E $700,000 20 D D D G $1,000,000 30 ED ED ED B $1,300,000 34 $300,000 4 $75,000 Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 34

Step 5: Recalculate incremental values Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca mikepaulden.com +1 (844) PAULDEN Slide 35

Why Its Time to Abandon the ICER Dr Mike Paulden, Assistant - PowerPoint PPT Presentation

Why Its Time to Abandon the ICER Dr Mike Paulden, Assistant Professor, School of Public Health, University of Alberta @mikepaulden paulden@ualberta.ca Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca

SPEAKING TRUTH TO ICER Terry Wilcox Kathie Slaughter Who is ICER? ICER WATCH William

First, an anti-announcement The first ICER abutted Rosh Hashanah (Jewish New Year)

ICER 2012 - List of Presenters and Presentation Remarks Update 5 Sep No. Name Proposal Title

I N V E S T O R P R E S E N T A T I O N A U G U S T 2 0 1 6 CHIEF EXECUTIVE IVE OFFICE ICER,

COWLITZ RESTORATION AND RECOVERY (CRR) FUND Cowlitz FTC meeting 3/7/17 update ABANDON VOLITIONAL

1 2 New Ch Chie ief Exec ecutiv ive Offic icer: Phil Nicholl appointed An exp

lium Cyst stic icer ercosis in sis in West ester ern Ken enya Lian Do Doble le

in Front of the NLRB Presen ented ed by: Jess ssica ica Dietz, etz, Officer icer in Charg

By Jonathan Huang PhD, CFS, Staff f Office icer, r, USDA Food d Safety y and Inspecti ection

A transport strategy for the South East East Rupert Clubb Lead Lead off office icer, Tra

Sharpen your pitchforks the internet is wrong #GamerGate Pro tip If your movement is

Comparing Textual and Block Interfaces in a Novice Programming Environment Thomas Price Tiffany

Some Will Some Wont So What WHY STRATEGIC PLANNING? IMPROVES: systems, processes, and member

Pay-fo Pa for-Us Use in th the EGI Marketplace EG Sy Holsinger, EGI Foundati tion Se

Your Message Your Vision Legislative Changes CAM practitioners have been under pressure due to

E N G A G E W I T H D R A W W I T H D R A W B A L A N C E E N G A G E There is an appointed

Sustainable Performance of Public Infrastructure Mike Benson, MIT University of New Brunswick,

Greenland Mining Projects August 2020 l DISCLAIMER This presentation is made on behalf of Alba

Atr triu ium com ompany presentation 21 21 Mar arch 2018 2018 ATRIUM PROMENADA

Infrastructure Company D.A. DAVIDSON DIVERSIFIED INDUSTRIALS & SERVICES CONFERENCE S EPTEMBER

BANCORPSOUTH BANK Financial Information As of and for the Three Months Ended March 31, 2018

Natural Gas Master Plan Draft Report Presentation Stakeholder Workshop Government of Mozambique

ANNUAL MEETING MIAMI 2019 LINER & PORT AGENCY PLENARY MEETING 2 nd OCTOBER 2019 DISRUPTIVE

ELIKHULU SITE VISIT 31 JANUARY 2019 PROFITABLE SUSTAINABLE STAKEHOLDERS GROWTH

Why Its Time to Abandon the ICER Dr Mike Paulden, Assistant - PowerPoint PPT Presentation

Why Its Time to Abandon the ICER Dr Mike Paulden, Assistant Professor, School of Public Health, University of Alberta @mikepaulden paulden@ualberta.ca Dr Mike Paulden, University of Alberta @mikepaulden paulden@ualberta.ca

SPEAKING TRUTH TO ICER Terry Wilcox Kathie Slaughter Who is ICER? ICER WATCH William

First, an anti-announcement The first ICER abutted Rosh Hashanah (Jewish New Year)

ICER 2012 - List of Presenters and Presentation Remarks Update 5 Sep No. Name Proposal Title

I N V E S T O R P R E S E N T A T I O N A U G U S T 2 0 1 6 CHIEF EXECUTIVE IVE OFFICE ICER,

COWLITZ RESTORATION AND RECOVERY (CRR) FUND Cowlitz FTC meeting 3/7/17 update ABANDON VOLITIONAL

1 2 New Ch Chie ief Exec ecutiv ive Offic icer: Phil Nicholl appointed An exp

lium Cyst stic icer ercosis in sis in West ester ern Ken enya Lian Do Doble le

in Front of the NLRB Presen ented ed by: Jess ssica ica Dietz, etz, Officer icer in Charg

By Jonathan Huang PhD, CFS, Staff f Office icer, r, USDA Food d Safety y and Inspecti ection

A transport strategy for the South East East Rupert Clubb Lead Lead off office icer, Tra

Sharpen your pitchforks the internet is wrong #GamerGate Pro tip If your movement is

Comparing Textual and Block Interfaces in a Novice Programming Environment Thomas Price Tiffany

Some Will Some Wont So What WHY STRATEGIC PLANNING? IMPROVES: systems, processes, and member

Pay-fo Pa for-Us Use in th the EGI Marketplace EG Sy Holsinger, EGI Foundati tion Se

Your Message Your Vision Legislative Changes CAM practitioners have been under pressure due to

E N G A G E W I T H D R A W W I T H D R A W B A L A N C E E N G A G E There is an appointed

Sustainable Performance of Public Infrastructure Mike Benson, MIT University of New Brunswick,

Greenland Mining Projects August 2020 l DISCLAIMER This presentation is made on behalf of Alba

Atr triu ium com ompany presentation 21 21 Mar arch 2018 2018 ATRIUM PROMENADA

Infrastructure Company D.A. DAVIDSON DIVERSIFIED INDUSTRIALS &amp; SERVICES CONFERENCE S EPTEMBER

BANCORPSOUTH BANK Financial Information As of and for the Three Months Ended March 31, 2018

Natural Gas Master Plan Draft Report Presentation Stakeholder Workshop Government of Mozambique

ANNUAL MEETING MIAMI 2019 LINER &amp; PORT AGENCY PLENARY MEETING 2 nd OCTOBER 2019 DISRUPTIVE

ELIKHULU SITE VISIT 31 JANUARY 2019 PROFITABLE SUSTAINABLE STAKEHOLDERS GROWTH

Infrastructure Company D.A. DAVIDSON DIVERSIFIED INDUSTRIALS & SERVICES CONFERENCE S EPTEMBER

ANNUAL MEETING MIAMI 2019 LINER & PORT AGENCY PLENARY MEETING 2 nd OCTOBER 2019 DISRUPTIVE