{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:54:59Z","timestamp":1792799699486,"version":"4.5.0"},"reference-count":22,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T00:00:00Z","timestamp":1593561600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Methusalem financing program of the Flemish government","id":[{"id":"https:\/\/ror.org\/04qxsrb28","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1116967, OPP1151153"],"award-info":[{"award-number":["OPP1116967, OPP1151153"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Decis Making"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:p>Background. Threshold analysis is used to determine the threshold value of an input parameter at which a health care strategy becomes cost-effective. Typically, it is performed in a deterministic manner, in which inputs are varied one at a time while the remaining inputs are each fixed at their mean value. This approach will result in incorrect threshold values if the cost-effectiveness model is nonlinear or if inputs are correlated. Objective. To propose a probabilistic method for performing threshold analysis, which accounts for the joint uncertainty in all input parameters and makes no assumption about the linearity of the cost-effectiveness model. Methods. Three methods are compared: 1) deterministic threshold analysis (DTA); 2) a 2-level Monte Carlo approach, which is considered the gold standard; and 3) a regression-based method using a generalized additive model (GAM), which identifies threshold values directly from a probabilistic sensitivity analysis sample. Results. We applied the 3 methods to estimate the minimum probability of hospitalization for typhoid fever at which 3 different vaccination strategies become cost-effective in Uganda. The threshold probability of hospitalization at which routine vaccination at 9 months with catchup campaign to 5 years becomes cost-effective is estimated to be 0.060 and 0.061 (95% confidence interval [CI], 0.058\u20130.064), respectively, for 2-level and GAM. According to DTA, routine vaccination at 9 months with catchup campaign to 5 years would never become cost-effective. The threshold probability at which routine vaccination at 9 months with catchup campaign to 15 years becomes cost-effective is estimated to be 0.092 (DTA), 0.074 (2-level), and 0.072 (95% CI, 0.069\u20130.075) (GAM). GAM is 430 times faster than the 2-level approach. Conclusions. When the cost-effectiveness model is nonlinear, GAM provides similar threshold values to the 2-level Monte Carlo approach and is computationally more efficient. DTA provides incorrect results and should not be used.<\/jats:p>","DOI":"10.1177\/0272989x20937253","type":"journal-article","created":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T02:15:16Z","timestamp":1594001716000},"page":"669-679","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["A Computationally Efficient Method for Probabilistic Parameter Threshold Analysis for Health Economic Evaluations"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7288-4461","authenticated-orcid":false,"given":"Zo\u00eb","family":"Pieters","sequence":"first","affiliation":[{"name":"I-BioStat, Data Science Institute, Hasselt University, Hasselt, Limburg, Belgium"},{"name":"Centre for Health Economics Research and Modeling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Wilrijk, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Strong","sequence":"additional","affiliation":[{"name":"School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia E.","family":"Pitzer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5034-3595","authenticated-orcid":false,"given":"Philippe","family":"Beutels","sequence":"additional","affiliation":[{"name":"Centre for Health Economics Research and Modeling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Wilrijk, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5720-5291","authenticated-orcid":false,"given":"Joke","family":"Bilcke","sequence":"additional","affiliation":[{"name":"Centre for Health Economics Research and Modeling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Wilrijk, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,7,5]]},"reference":[{"key":"bibr1-0272989X20937253","volume-title":"Methods for the Economic Evaluation of Health Care Programmes","author":"Drummond MF","year":"2015"},{"key":"bibr2-0272989X20937253","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200826090-00008"},{"key":"bibr3-0272989X20937253","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X14567475"},{"key":"bibr4-0272989X20937253","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2012.04.014"},{"key":"bibr5-0272989X20937253","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jix598"},{"key":"bibr6-0272989X20937253","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780198526629.001.0001"},{"key":"bibr7-0272989X20937253","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-019-00869-3"},{"key":"bibr8-0272989X20937253","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(18)30804-1"},{"key":"bibr9-0272989X20937253","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X98018002S09"},{"key":"bibr10-0272989X20937253","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0115544"},{"key":"bibr11-0272989X20937253","unstructured":"Blumsack S. 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