CEA/CUA Neutral benefit CEA/CUA* Net harms None^ Non-inferior CEA/CUA CEA/CUA* None^ Net clinical benefit CEA/CUA Inferior Neutral benefit CEA/CUA* None^ None^ Net harms None^ Abbreviations: CEA = cost-effectiveness analysis; CUA = cost-utility analysis * May be reduced to cost-minimisation analysis. Cost-minimisation analysis should only be presented when the proposed service has been indisputably demonstrated to be no worse than its main comparator(s) in terms of both effectiveness and safety, so the difference between the service and the appropriate comparator can be reduced to a comparison of costs. In most cases, there will be some uncertainty around such a conclusion (i.e., the conclusion is often not indisputable). Therefore, when an assessment concludes that an intervention was no worse than a comparator, an assessment of the uncertainty around this conclusion should be provided by presentation of cost-effectiveness and/or cost-utility analyses. ^ No economic evaluation needs to be presented; MSAC is unlikely to recommend government subsidy of this intervention Questions for the review relating to the economic evaluation Cost effectiveness models should be undertaken: To establish the baseline scenario: What are the downstream costs and outcomes without the proposed intervention? To assess the proposed scenario: What are the downstream costs and outcomes with the proposed intervention? As throughout the DAP, sensitivity analyses should be undertaken around: The factors, ages and eligibility criteria as specified in the proposal; The variables as advised by the available evidence; The variables as advised by PASC as being informative for sensitivity analyses to inform the final decision making. Specifically, what impact does treatment with aromatase inhibitors have on bone mineral density as a surrogate for minimal trauma fracture? This should include a consideration of the effect of other possible prognostic factors including age and previous treatment with tamoxifen. The economic analysis should account for different thresholds for therapy as advised by the available evidence. The economic evaluation should account for all patients in the target population who become eligible for current MBS items (for example through age, minimal trauma fracture, skeletal metastases or premature menopause).
CEA/CUA Neutral benefit CEA/CUA* Net harms None^ Non-inferior CEA/CUA CEA/CUA* None^ Inferior Net clinical benefit CEA/CUA None^ None^ Neutral benefit CEA/CUA* Net harms None^ Abbreviations: CEA = cost-effectiveness analysis; CUA = cost-utility analysis * May be reduced to cost-minimisation analysis. Cost-minimisation analysis should only be presented when the proposed service has been indisputably demonstrated to be no worse than its main comparator(s) in terms of both effectiveness and safety, so the difference between the service and the appropriate comparator can be reduced to a comparison of costs. In most cases, there will be some uncertainty around such a conclusion (i.e., the conclusion is often not indisputable). Therefore, when an assessment concludes that an intervention was no worse than a comparator, an assessment of the uncertainty around this conclusion should be provided by presentation of cost-effectiveness and/or cost-utility analyses. ^ No economic evaluation needs to be presented; MSAC is unlikely to recommend government subsidy of this intervention Questions for the review relating to the economic evaluation Cost effectiveness models should be undertaken: To establish the baseline scenario: What are the downstream costs and outcomes without the proposed intervention? To assess the proposed scenario: What are the downstream costs and outcomes with the proposed intervention? As throughout the DAP, sensitivity analyses should be undertaken around: The factors, ages and eligibility criteria as specified in the proposal; The variables as advised by the available evidence; The variables as advised by PASC as being informative for sensitivity analyses to inform the final decision making. Specifically, what impact does treatment with aromatase inhibitors have on bone mineral density as a surrogate for minimal trauma fracture? This should include a consideration of the effect of other possible prognostic factors including age and previous treatment with tamoxifen. The economic analysis should account for different thresholds for therapy as advised by the available evidence. The economic evaluation should account for all patients in the target population who become eligible for current MBS items (for example through age, minimal trauma fracture, skeletal metastases or premature menopause).
App1313-FinalDAP-accessible.docx