Table 2 Framework for comparing the results of multiple perspectives in CEAs

Perfectly Congruent

The different perspectives identify the same intervention as optimal

Affordable

The CEA should recommend the optimal intervention

Weakly Congruent

The intervention which is optimal from the health sector perspective is also efficient from the patient perspective but not optimal at the willingness-to-pay threshold

Affordable

The CEA should recommend the intervention that is optimal from the health sector perspective. The CEA should also recommend that decision-makers redesign or implement the interventions in such a way that maximizes patient incentive to choose the health sector’s optimal intervention

Incongruent

The intervention which is optimal for the health sector is not efficient from the patient perspective

Affordable

Consistent

The intervention which is optimal from the health sector perspective is also efficient from the patient perspective (may be optimal at the willingness-to-pay threshold or simply on the efficiency frontier)

Unaffordable

The CEA should recommend that decision-makers redesign the intervention which is optimal from the health sector perspective in order to decrease or offset the patient’s OOP expenditures, making the intervention more affordable for patients. If such a redesign does not generate an optimal intervention from the health sector perspective that is affordable to patients, then the intervention should be eliminated from consideration (but ICERs should not be recalculated) and the next most cost-effective intervention from the health sector perspective that is efficient and affordable from the patient perspective becomes optimal and should be recommended

Inconsistent

The intervention which is optimal for the health sector is not efficient for the patient perspective

Unaffordable