full free access: Individualized Cost-Effectiveness Analysis

Summary Points

Cost-effectiveness analyses typically express their principal results as incremental cost-effectiveness ratios (ICERs).
ICERs are useful in making decisions for allocation of resources at a population level, but typical ICER measures have shortcomings when used for individual decisions.
For the same ICER, the cost-effectiveness may vary among individuals because not everyone assigns the same priorities to specific outcomes, shares the same attitudes toward risk, or faces the same distribution of expected outcomes.
ICER information can be enhanced by providing additional metrics that individualize cost-effectiveness analyses.
These metrics include the per person net benefit and cost, subgroup ICER estimates for observed measured sources of heterogeneity, and distributions of outcomes and costs for unknown or unmeasured sources of heterogeneity.