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The results of a pharmacoeconomic study: incremental cost-effectiveness ratio versus net monetary benefit
  1. Andrea Messori,
  2. Sabrina Trippoli
  1. HTA Unit, ESTAR, Regional Health Service, Firenze, Italy
  1. Correspondence to Dr Andrea Messori, HTA Unit, Regional Health Service, ESTAR, via San Salvi 12, 50135 Firenze, Italy;{at}

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To the Editor

The article by Wouters and colleagues1 presents an exhaustive overview on how quality-adjusted life years (QALYs) can be used in cost-effectiveness analysis. In this framework, the authors also mention the incremental cost-effectiveness ratio (ICER), which is the parameter typically used to express the results of a cost-effectiveness study. The article, however, does not discuss the net monetary benefit (NMB), which is another parameter used to express the results of a cost-effectiveness study.

The incremental cost (ΔC) and the incremental effectiveness (ΔE) are the two main parameters of pharmacoeconomics and cost-effectiveness analysis, along with the willingness-to-pay threshold (λ). The decision rule (eg, in the case of a favourable pharmacoeconomic result) is (ΔC/ΔE) < λ (equation 1), if based on the ICER, or (ΔE×λ−ΔC) > 0 (equation 2), if based on the NMB. Likewise, an unfavourable pharmacoeconomic result is when …

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  • Contributors Both authors wrote this letter.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed