{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T20:46:26Z","timestamp":1786999586906,"version":"build-2736575974"},"reference-count":33,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2019,7,24]],"date-time":"2019-07-24T00:00:00Z","timestamp":1563926400000},"content-version":"unspecified","delay-in-days":204,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int J Technol Assess Health Care"],"published-print":{"date-parts":[[2019]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0266462319000576_sec_a1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Traditional decision rules have limitations when a new technology is less effective and less costly than a comparator. We propose a new probabilistic decision framework to examine non-inferiority in effectiveness and net monetary benefit (NMB) simultaneously. We illustrate this framework using the example of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) for treatment-resistant depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0266462319000576_sec_a2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We modeled the quality-adjusted life-years (QALYs) associated with the new intervention (rTMS), an active control (ECT), and a placebo control, and we estimated the fraction of effectiveness preserved by the new intervention through probabilistic sensitivity analysis (PSA). We then assessed the probability of cost-effectiveness using a traditional cost-effectiveness acceptability curve (CEAC) and our new decision-making framework. In our new framework, we considered the new intervention cost-effective in each simulation of the PSA if it preserved at least 75 percent of the effectiveness of the active control (thus demonstrating non-inferiority) and had a positive NMB at a given willingness-to-pay threshold (WTP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0266462319000576_sec_a3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>rTMS was less effective (i.e., associated with fewer QALYs) and less costly than ECT. The traditional CEAC approach showed that the probabilities of rTMS being cost-effective were 100 percent, 39 percent, and 14 percent at WTPs of $0, $50,000, and $100,000 per QALY gained, respectively. In the new decision framework, the probabilities of rTMS being cost-effective were reduced to 23 percent, 21 percent, and 13 percent at WTPs of $0, $50,000, and $100,000 per QALY, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0266462319000576_sec_a4\" sec-type=\"conclusion\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This new framework provides a different perspective for decision making with considerations of both non-inferiority and WTP thresholds.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s0266462319000576","type":"journal-article","created":{"date-parts":[[2019,7,24]],"date-time":"2019-07-24T04:03:53Z","timestamp":1563941033000},"page":"291-297","source":"Crossref","is-referenced-by-count":6,"title":["A Non-inferiority Framework for Cost-Effectiveness Analysis"],"prefix":"10.1017","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4331-8233","authenticated-orcid":false,"given":"Xuanqian","family":"Xie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Falk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Brophy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong Anh","family":"Tu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5024-1641","authenticated-orcid":false,"given":"Olga","family":"Gajic-Veljanoski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Sikich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irfan A.","family":"Dhalla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Ng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2019,7,24]]},"reference":[{"key":"S0266462319000576_ref23","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1058"},{"key":"S0266462319000576_ref32","doi-asserted-by":"publisher","DOI":"10.1002\/hec.861"},{"key":"S0266462319000576_ref9","first-page":"1","article-title":"Repetitive transcranial magnetic stimulation for treatment-resistant depression: An economic analysis","volume":"16","year":"2016","journal-title":"Ont Health Technol Assess Ser"},{"key":"S0266462319000576_ref25","first-page":"476","article-title":"Decision analysis of the cost-effectiveness of repetitive transcranial magnetic stimulation versus electroconvulsive therapy for treatment of nonpsychotic severe depression","volume":"9","author":"Kozel","year":"2004","journal-title":"CNS Spectr"},{"key":"S0266462319000576_ref16","doi-asserted-by":"publisher","DOI":"10.3310\/hta19140"},{"key":"S0266462319000576_ref33","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X04265478"},{"key":"S0266462319000576_ref24","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12723"},{"key":"S0266462319000576_ref8","first-page":"1","article-title":"Repetitive transcranial magnetic stimulation for treatment-resistant depression: A systematic review and meta-analysis of randomized controlled trials","volume":"16","year":"2016","journal-title":"Ont Health Technol Assess Ser"},{"key":"S0266462319000576_ref3","first-page":"1","article-title":"Electroconvulsive therapy","volume":"55","author":"Enns","year":"2009","journal-title":"Can J Psychiatry"},{"key":"S0266462319000576_ref11","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.130952"},{"key":"S0266462319000576_ref7","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.08m04872gre"},{"key":"S0266462319000576_ref27","unstructured":"Galletly, C , Clarke, P , Fitzgerald, P , (2013) Repetitive transcranial magnetic stimulation (rTMS). MSAC application no. 1196, assessment report [Internet]. Canberra: Commonwealth of Australia. [cited cited May 7, 2019]. http:\/\/www.msac.gov.au\/internet\/msac\/publishing.nsf\/Content\/5C7DBD43A4A57C73CA25801000123BAE\/$File\/1196_rTMS_AttA_FinalAssessmentReport-accessible.pdf."},{"key":"S0266462319000576_ref26","unstructured":"Health Quality Ontario (2016) High-frequency repetitive transcranial magnetic stimulation for treatment-resistant depression: OHTAC recommendation [Internet]. Toronto, ON: Queen's Printer for Ontario [cited May 7, 2019]. http:\/\/www.hqontario.ca\/evidence\/publications-and-ohtac-recommendations\/ontario-health-technology-assessment-series\/ohtac-rtms."},{"key":"S0266462319000576_ref29","doi-asserted-by":"publisher","DOI":"10.1177\/0706743716660033"},{"key":"S0266462319000576_ref10","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1614.2001.00852.x"},{"key":"S0266462319000576_ref28","unstructured":"European Network for Health Technology Assessment (2017) Repetitive transcranial magnetic stimulation for treatment-resistant major depression [Internet]. The Network. 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