Fieller's method and net health benefits

Abstract

Statistical and conceptual difficulties complicate the estimation of the incremental cost-effectiveness ratio (ICER). An alternative approach is to measure cost-effectiveness by the incremental net health benefit (INHB), defined as the difference in mean effectiveness of a new treatment compared with a standard, adjusted for cost difference by subtracting the health foregone if purchasing care at the rate of a marginally cost-effective therapy. Because net health benefit (NHB) is dependent on this threshold rate, one can construct confidence intervals for the INHB at various values of the rate. It turns out that the set of rates where new and standard are not significantly different is equal to the Fieller's method confidence set for the ICER. We review the derivation of the Fieller's method confidence set, present numerical examples, and discuss the implications of our result for the calculation and interpretation of NHB analyses.