Purpose:
Following the decision rules of cost-effectiveness analysis, we propose an alternative methodology to construct a cost-efficiency frontier. We illustrate this methodology by means of an efficiency frontier analysis of five alternative treatments of patients with equinovarus deformity poststroke.Method: The AHP is a technique for multi-criteria analysis. It can help decision-makers to evaluate a finite number of alternative health care technologies under a finite number of outcome measures. The Analytic Hierarchy Process (AHP) was applied to prioritize the outcome measures of treatments of equinovarus deformity poststroke, and to prioritize five alternative treatment regarding these outcome measures. Using the pairwise comparisons technique of the AHP, 140 patients prioritized the outcome measures, and 10 health professionals prioritized the five treatments with regard to these outcome measures. The priorities were used to calculate the relative effectiveness of the treatments. Sensitivity analysis is based on bootstrapping of the participants’ priorities. Relative costs, including the device related costs and the care related costs of the treatments, are calculated by applying the direct rating function of the AHP.
Result: Our analysis results in one overall efficiency frontier that takes into account the combined outcomes of the alternative treatments. The impact of the outcome measures on the combined outcomes is determined by their priorities. Functional outcomes (.51) has the highest weight, followed by risk and side effects (.19), comfort (.10), daily effort (.098), cosmetics (.07), and impact of treatment (.03). The overall effectiveness of soft-tissue surgery (.41) is ranked first, followed by orthopedic footwear (.18), ankle-foot orthosis (.15), surface electrostimulation (.14), and finally implanted electrostimulation (.12). Implanted electrostimulation (.35) and soft-tissue surgery (.34) are considered to be most expensive, followed by surface electrostimulation (.26), orthopedic footwear (.03) and ankle-foot orthosis (.02). Based on these priorities of the treatments’ overall effectiveness and costs, an efficiency frontier was drawn that includes decision uncertainty.
Conclusion: The results suggest that the cost-effectiveness of implanted electrostimulation and surface electrostimulation are unfavourable. This new methodology for efficiency frontier analysis allows decision makers to integrate the outcomes about costs and values of health care technology, and can be applied broadly. It is particularly suitable in the field of early technology assessment, since the AHP supports a systematic estimation of priors about the effectiveness of alternative treatments.