### Abstract

Background: Cost-effectiveness acceptability curves (CEACs) and the cost-effectiveness acceptability frontier (CEAF) are the recommended graphical representations of uncertainty in a cost-effectiveness analysis (CEA). Nevertheless, many limitations of CEACs and the CEAF have been recognized by others. Expected loss curves (ELCs) overcome these limitations by displaying the expected foregone benefits of choosing one strategy over others, the optimal strategy in expectation, and the value of potential future research all in a single figure. Objectives: To revisit ELCs, illustrate their benefits using a case study, and promote their adoption by providing open-source code. Methods: We used a probabilistic sensitivity analysis of a CEA comparing 6 cerebrospinal fluid biomarker test-and-treat strategies in patients with mild cognitive impairment. We showed how to calculate ELCs for a set of decision alternatives. We used the probabilistic sensitivity analysis of the case study to illustrate the limitations of currently recommended methods for communicating uncertainty and then demonstrated how ELCs can address these issues. Results: ELCs combine the probability that each strategy is not cost-effective on the basis of current information and the expected foregone benefits resulting from choosing that strategy (ie, how much is lost if we recommended a strategy with a higher expected loss). ELCs display how the optimal strategy switches across willingness-to-pay thresholds and enables comparison between different strategies in terms of the expected loss. Conclusions: ELCs provide a more comprehensive representation of uncertainty and overcome current limitations of CEACs and the CEAF. Communication of uncertainty in CEA would benefit from greater adoption of ELCs as a complementary method to CEACs, the CEAF, and the expected value of perfect information.

Original language | English (US) |
---|---|

Pages (from-to) | 611-618 |

Number of pages | 8 |

Journal | Value in Health |

Volume | 22 |

Issue number | 5 |

DOIs | |

State | Published - May 1 2019 |

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### Keywords

- cost-effectiveness analysis
- expected losses
- probabilistic sensitivity analysis
- uncertainty analysis
- value of information analysis

### Cite this

*Value in Health*,

*22*(5), 611-618. https://doi.org/10.1016/j.jval.2019.02.008

**“Time Traveling Is Just Too Dangerous” but Some Methods Are Worth Revisiting : The Advantages of Expected Loss Curves Over Cost-Effectiveness Acceptability Curves and Frontier.** / Alarid-Escudero, Fernando; Enns, Eva; Kuntz, Karen M; Michaud, Tzeyu L.; Jalal, Hawre.

Research output: Contribution to journal › Article

*Value in Health*, vol. 22, no. 5, pp. 611-618. https://doi.org/10.1016/j.jval.2019.02.008

}

TY - JOUR

T1 - “Time Traveling Is Just Too Dangerous” but Some Methods Are Worth Revisiting

T2 - The Advantages of Expected Loss Curves Over Cost-Effectiveness Acceptability Curves and Frontier

AU - Alarid-Escudero, Fernando

AU - Enns, Eva

AU - Kuntz, Karen M

AU - Michaud, Tzeyu L.

AU - Jalal, Hawre

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: Cost-effectiveness acceptability curves (CEACs) and the cost-effectiveness acceptability frontier (CEAF) are the recommended graphical representations of uncertainty in a cost-effectiveness analysis (CEA). Nevertheless, many limitations of CEACs and the CEAF have been recognized by others. Expected loss curves (ELCs) overcome these limitations by displaying the expected foregone benefits of choosing one strategy over others, the optimal strategy in expectation, and the value of potential future research all in a single figure. Objectives: To revisit ELCs, illustrate their benefits using a case study, and promote their adoption by providing open-source code. Methods: We used a probabilistic sensitivity analysis of a CEA comparing 6 cerebrospinal fluid biomarker test-and-treat strategies in patients with mild cognitive impairment. We showed how to calculate ELCs for a set of decision alternatives. We used the probabilistic sensitivity analysis of the case study to illustrate the limitations of currently recommended methods for communicating uncertainty and then demonstrated how ELCs can address these issues. Results: ELCs combine the probability that each strategy is not cost-effective on the basis of current information and the expected foregone benefits resulting from choosing that strategy (ie, how much is lost if we recommended a strategy with a higher expected loss). ELCs display how the optimal strategy switches across willingness-to-pay thresholds and enables comparison between different strategies in terms of the expected loss. Conclusions: ELCs provide a more comprehensive representation of uncertainty and overcome current limitations of CEACs and the CEAF. Communication of uncertainty in CEA would benefit from greater adoption of ELCs as a complementary method to CEACs, the CEAF, and the expected value of perfect information.

AB - Background: Cost-effectiveness acceptability curves (CEACs) and the cost-effectiveness acceptability frontier (CEAF) are the recommended graphical representations of uncertainty in a cost-effectiveness analysis (CEA). Nevertheless, many limitations of CEACs and the CEAF have been recognized by others. Expected loss curves (ELCs) overcome these limitations by displaying the expected foregone benefits of choosing one strategy over others, the optimal strategy in expectation, and the value of potential future research all in a single figure. Objectives: To revisit ELCs, illustrate their benefits using a case study, and promote their adoption by providing open-source code. Methods: We used a probabilistic sensitivity analysis of a CEA comparing 6 cerebrospinal fluid biomarker test-and-treat strategies in patients with mild cognitive impairment. We showed how to calculate ELCs for a set of decision alternatives. We used the probabilistic sensitivity analysis of the case study to illustrate the limitations of currently recommended methods for communicating uncertainty and then demonstrated how ELCs can address these issues. Results: ELCs combine the probability that each strategy is not cost-effective on the basis of current information and the expected foregone benefits resulting from choosing that strategy (ie, how much is lost if we recommended a strategy with a higher expected loss). ELCs display how the optimal strategy switches across willingness-to-pay thresholds and enables comparison between different strategies in terms of the expected loss. Conclusions: ELCs provide a more comprehensive representation of uncertainty and overcome current limitations of CEACs and the CEAF. Communication of uncertainty in CEA would benefit from greater adoption of ELCs as a complementary method to CEACs, the CEAF, and the expected value of perfect information.

KW - cost-effectiveness analysis

KW - expected losses

KW - probabilistic sensitivity analysis

KW - uncertainty analysis

KW - value of information analysis

UR - http://www.scopus.com/inward/record.url?scp=85064212983&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064212983&partnerID=8YFLogxK

U2 - 10.1016/j.jval.2019.02.008

DO - 10.1016/j.jval.2019.02.008

M3 - Article

VL - 22

SP - 611

EP - 618

JO - Value in Health

JF - Value in Health

SN - 1098-3015

IS - 5

ER -