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Incremental cost-effectiveness ratio : ウィキペディア英語版
Incremental cost-effectiveness ratio
The incremental cost-effectiveness ratio (ICER) is a statistic used in cost-effectiveness analysis to summarise the cost-effectiveness of a health care intervention. It is defined by the difference in cost between two possible interventions, divided by the difference in their effect. It represents the average incremental cost associated with 1 additional unit of the measure of effect. The ICER can be estimated as:
ICER=\frac)})},
where C_ and E_ are the cost and effect in the intervention group and where C_ and E_ are the cost and effect in the control care group.〔What is the incremental cost-effectiveness ratio (ICER)? GaBI Online. (). Accessed 20 March 2012.〕 Costs are usually described in monetary units, while effects can be measured in terms of health status or another outcome of interest. A common application of the ICER is in cost-utility analysis, in which case the ICER is synonymous with the cost per quality-adjusted life year (QALY) gained.
== Use as a decision rule ==
The ICER can be used as a decision rule in resource allocation. If a decision-maker is able to establish a willingness-to-pay value for the outcome of interest, it is possible to adopt this value as a threshold. If for a given intervention the ICER is above this threshold it will be deemed too expensive and thus should not be funded, whereas if the ICER lies below the threshold the intervention can be judged cost-effective. This approach has to some extent been adopted in relation to QALYs; for example, the National Institute for Health and Care Excellence adopts a nominal cost-per-QALY threshold of £20,000 to £30,000. As such, the ICER facilitates comparison of interventions across various disease states and treatments. The use of ICERs therefore provides an opportunity to help contain health care costs without adverse health consequences.〔Orszag PR, Ellis P. (Addressing rising health care costs—A view from the Congressional Budget Office ). N Engl J Med, 2007; 357:1885–1887.〕 They also provide to policy makers information on where resources should be allocated when they are limited.〔Cost-effective Medical Treatment: Putting an Updated Dollar Value on Human Life. Knowledge@Wharton, 30 April 2008. (). Accessed 20 March 2012.〕 As health care costs have continued to rise, many new clinical trials are attempting to integrate ICER into results to provide more evidence of potential benefit.〔Ramsey S, Willke R, Briggs A, Brown R, Buxton M, Chawla A, Cook J, Glick H, Liljas B, Petitti D, Reed S. (Good research practices for cost-effectiveness analysis alongside clinical trials: The ISPOR RCT-CEA task force report ). Value in Health, 2005; 8(5):521-533.〕

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