Effect of time horizon on incremental cost-effectiveness ratios

Background: Estimation of cost-effectiveness of a therapy as compared with another, in healthcare, is often based on a single perspective and a single time horizon. In this thesis, I explored methods of extrapolating the survival effect of different interventions and the effect of time horizon on incremental cost-effectiveness ratios when comparing two strategies. Methods: Two strategies for a patient are compared: new or usual treatment. A hypothetical model based on US life tables (for a 64-year old) assumed that the new and usual treatment strategies resulted in patient survivals identical to a person who is 5 and 10 years older, respectively, than the patient's chronologic age. The hazard rates over time were calculated and transformed to linear equations for least-squares linear regression to fit exponential, linear exponential, Weibull and Gompertz distributions. The survival model yielding the maximal likelihood estimate was extrapolated over different time horizons: 5, 10 and 15-year in addition to lifetime. In addition, I extracted survival data from a published trial evaluating thrombolysis in patients with myocardial infarction and applied this methodology over different time horizons.

Department dc:contributor.department

Harvard University--MIT Division of Health Sciences and Technology.

Grantor dc:publisher

Massachusetts Institute of Technology

Year dc:date.issued

2005

Author dc:creator

• Sondhi, Manu

Advisor dc:contributor.advisor

• Robert A. Greenes,. John B. Wong and Stephen G. Pauker.

• Harvard University--MIT Division of Health Sciences and Technology.

Statement dc:rights

• M.I.T. theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. See provided URL for inquiries about permission.

Licence dc:rights.uri

• http://dspace.mit.edu/handle/1721.1/7582

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/1721.1/33846

OAI identifier oai:identifier

oai:dspace.mit.edu:1721.1/33846